| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
617 |
139 |
$75K |
| D1120 |
Prophylaxis - child |
1,805 |
1,792 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,804 |
1,791 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,038 |
1,032 |
$24K |
| D0240 |
|
1,789 |
913 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
914 |
910 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
369 |
173 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,369 |
1,359 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
79 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
191 |
72 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
324 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
350 |
324 |
$10K |
| D1351 |
Sealant - per tooth |
362 |
124 |
$8K |
| D2335 |
|
80 |
27 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
357 |
346 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
107 |
$1K |
| D9420 |
|
27 |
27 |
$0.00 |