| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,309 |
794 |
$267K |
| D1120 |
Prophylaxis - child |
6,391 |
6,254 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
7,647 |
7,494 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,457 |
812 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,177 |
1,234 |
$127K |
| D9248 |
|
901 |
818 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,092 |
7,933 |
$116K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
297 |
271 |
$111K |
| D1110 |
Prophylaxis - adult |
1,813 |
1,785 |
$77K |
| D9310 |
|
1,616 |
1,565 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
2,570 |
2,484 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,180 |
2,135 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
474 |
266 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,839 |
1,497 |
$28K |
| D0240 |
|
1,011 |
979 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,041 |
1,003 |
$27K |
| D1351 |
Sealant - per tooth |
1,084 |
370 |
$25K |
| D9222 |
|
286 |
271 |
$22K |
| D0274 |
Bitewings - four radiographic images |
724 |
696 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
256 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
202 |
$6K |
| D2330 |
|
73 |
39 |
$4K |