| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,841 |
481 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
598 |
263 |
$63K |
| D1120 |
Prophylaxis - child |
980 |
960 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
414 |
275 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
228 |
152 |
$26K |
| D1206 |
Topical application of fluoride varnish |
967 |
945 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
647 |
591 |
$25K |
| D0272 |
Bitewings - two radiographic images |
690 |
674 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
569 |
551 |
$19K |
| D1351 |
Sealant - per tooth |
439 |
136 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
222 |
$13K |
| D1354 |
|
381 |
109 |
$12K |
| D0330 |
Panoramic radiographic image |
82 |
82 |
$7K |
| D2330 |
|
84 |
39 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
116 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$4K |