| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,968 |
668 |
$359K |
| D1120 |
Prophylaxis - child |
9,646 |
8,821 |
$271K |
| D1206 |
Topical application of fluoride varnish |
11,972 |
10,954 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
10,867 |
9,940 |
$204K |
| D1351 |
Sealant - per tooth |
4,857 |
935 |
$117K |
| D0272 |
Bitewings - two radiographic images |
3,631 |
3,306 |
$72K |
| D1110 |
Prophylaxis - adult |
1,544 |
1,402 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,996 |
1,705 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
734 |
340 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,687 |
1,490 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
704 |
419 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
776 |
414 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,874 |
1,283 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,225 |
1,137 |
$31K |
| D0330 |
Panoramic radiographic image |
415 |
373 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,823 |
1,649 |
$17K |
| D7962 |
|
58 |
51 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
281 |
254 |
$8K |
| D7961 |
|
34 |
27 |
$6K |
| D0274 |
Bitewings - four radiographic images |
142 |
124 |
$4K |
| D1330 |
|
3,837 |
3,678 |
$0.00 |