| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,700 |
463 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,111 |
669 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,246 |
706 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,021 |
444 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,491 |
1,462 |
$44K |
| D1120 |
Prophylaxis - child |
1,392 |
1,366 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,877 |
1,845 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,716 |
1,539 |
$28K |
| D1110 |
Prophylaxis - adult |
496 |
492 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,800 |
1,774 |
$18K |
| D0272 |
Bitewings - two radiographic images |
657 |
644 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
306 |
304 |
$14K |
| D2331 |
|
205 |
124 |
$12K |
| D2330 |
|
237 |
141 |
$11K |
| D0274 |
Bitewings - four radiographic images |
458 |
453 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
352 |
334 |
$10K |
| D0330 |
Panoramic radiographic image |
177 |
171 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
24 |
$9K |
| D2950 |
|
89 |
62 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
71 |
$7K |
| D3120 |
|
253 |
138 |
$6K |
| D1351 |
Sealant - per tooth |
232 |
89 |
$5K |
| D2934 |
|
31 |
12 |
$4K |
| D2332 |
|
61 |
41 |
$2K |
| D0350 |
|
45 |
45 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
55 |
$2K |