| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,724 |
1,039 |
$223K |
| D1120 |
Prophylaxis - child |
4,890 |
4,592 |
$147K |
| D1206 |
Topical application of fluoride varnish |
6,965 |
6,531 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
6,617 |
6,223 |
$132K |
| D1351 |
Sealant - per tooth |
4,086 |
765 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,580 |
2,350 |
$68K |
| D1110 |
Prophylaxis - adult |
1,459 |
1,357 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,662 |
2,487 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,336 |
1,210 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
391 |
275 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
376 |
234 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
361 |
333 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
90 |
$13K |
| D0330 |
Panoramic radiographic image |
360 |
314 |
$12K |
| D0274 |
Bitewings - four radiographic images |
167 |
152 |
$5K |
| D0240 |
|
232 |
102 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$927.00 |