| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,335 |
340 |
$188K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,419 |
465 |
$116K |
| D1120 |
Prophylaxis - child |
2,860 |
2,641 |
$95K |
| D1351 |
Sealant - per tooth |
3,530 |
1,096 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,137 |
3,847 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,698 |
3,444 |
$80K |
| D1354 |
|
1,040 |
346 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,127 |
1,818 |
$59K |
| D0240 |
|
3,877 |
1,757 |
$59K |
| D1110 |
Prophylaxis - adult |
1,154 |
1,099 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
524 |
336 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,322 |
1,251 |
$29K |
| D0330 |
Panoramic radiographic image |
590 |
559 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
422 |
403 |
$15K |
| D0274 |
Bitewings - four radiographic images |
443 |
418 |
$13K |
| D1352 |
|
362 |
210 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
859 |
506 |
$7K |
| D2140 |
|
115 |
72 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
599 |
542 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
209 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
93 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
27 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
19 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
168 |
157 |
$2K |
| D7111 |
|
16 |
13 |
$1K |
| D1999 |
|
7,065 |
5,936 |
$120.00 |