| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,070 |
488 |
$270K |
| D1120 |
Prophylaxis - child |
6,183 |
6,176 |
$231K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,522 |
1,064 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
6,439 |
6,427 |
$185K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,667 |
5,657 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,292 |
2,826 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,789 |
4,729 |
$73K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,361 |
1,356 |
$72K |
| D2390 |
|
334 |
95 |
$70K |
| D1110 |
Prophylaxis - adult |
1,254 |
1,248 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,361 |
2,349 |
$52K |
| D9420 |
|
442 |
429 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,391 |
1,391 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
739 |
725 |
$36K |
| D9248 |
|
259 |
243 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
780 |
756 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
343 |
182 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
127 |
79 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
716 |
714 |
$11K |
| D7960 |
|
50 |
37 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
38 |
$4K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$912.80 |
| D7962 |
|
25 |
25 |
$0.00 |