| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
3,493 |
1,854 |
$72K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
570 |
237 |
$69K |
| D1120 |
Prophylaxis - child |
1,765 |
1,742 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,627 |
1,610 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,529 |
2,498 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,076 |
2,046 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
272 |
$25K |
| D1110 |
Prophylaxis - adult |
514 |
511 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
245 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
963 |
902 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
807 |
796 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
238 |
160 |
$12K |
| D9248 |
|
103 |
97 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
130 |
79 |
$7K |
| D0603 |
|
1,661 |
1,635 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
306 |
297 |
$6K |
| D0330 |
Panoramic radiographic image |
326 |
322 |
$3K |
| D2140 |
|
37 |
16 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
16 |
$2K |
| D1351 |
Sealant - per tooth |
55 |
25 |
$1K |
| D0602 |
|
269 |
263 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$523.45 |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
26 |
$452.20 |
| D0601 |
|
50 |
50 |
$145.00 |