| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,763 |
517 |
$389K |
| D1120 |
Prophylaxis - child |
4,636 |
4,468 |
$148K |
| D1206 |
Topical application of fluoride varnish |
4,321 |
4,173 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,821 |
3,681 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
787 |
484 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,047 |
380 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,004 |
973 |
$45K |
| D0330 |
Panoramic radiographic image |
946 |
922 |
$44K |
| D9420 |
|
150 |
145 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,701 |
1,623 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,010 |
906 |
$32K |
| D0274 |
Bitewings - four radiographic images |
944 |
910 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
166 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,160 |
1,111 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,478 |
430 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
185 |
177 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
112 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
287 |
273 |
$7K |
| D1510 |
|
19 |
12 |
$4K |
| D2330 |
|
25 |
12 |
$2K |