| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
156 |
29 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
456 |
452 |
$15K |
| D1120 |
Prophylaxis - child |
392 |
386 |
$14K |
| D0272 |
Bitewings - two radiographic images |
363 |
357 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
31 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
529 |
521 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
581 |
447 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
481 |
471 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
36 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
145 |
141 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
64 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
47 |
$1K |
| D1110 |
Prophylaxis - adult |
18 |
18 |
$905.51 |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$872.18 |
| D0603 |
|
532 |
527 |
$0.00 |
| D0601 |
|
30 |
29 |
$0.00 |
| D0602 |
|
37 |
36 |
$0.00 |