| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,210 |
251 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,919 |
2,582 |
$76K |
| D1120 |
Prophylaxis - child |
3,374 |
2,997 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,070 |
796 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
256 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,102 |
1,829 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,760 |
1,630 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
341 |
196 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,132 |
1,089 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
142 |
72 |
$11K |
| D0330 |
Panoramic radiographic image |
414 |
382 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
366 |
343 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
696 |
580 |
$8K |
| D0350 |
|
184 |
161 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
38 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
382 |
341 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$2K |
| D9310 |
|
18 |
17 |
$893.60 |
| D2330 |
|
16 |
12 |
$831.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
22 |
$719.60 |