| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,298 |
494 |
$215K |
| D1120 |
Prophylaxis - child |
7,261 |
7,209 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,737 |
954 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
8,033 |
7,974 |
$155K |
| D1206 |
Topical application of fluoride varnish |
8,856 |
8,766 |
$140K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,379 |
2,317 |
$116K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,442 |
772 |
$105K |
| D0272 |
Bitewings - two radiographic images |
3,944 |
3,919 |
$65K |
| D1351 |
Sealant - per tooth |
2,609 |
759 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
893 |
682 |
$56K |
| D1110 |
Prophylaxis - adult |
1,092 |
1,083 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,262 |
1,247 |
$28K |
| D0240 |
|
1,824 |
1,055 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
376 |
369 |
$20K |
| D9420 |
|
89 |
86 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,450 |
1,413 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,321 |
489 |
$10K |
| D0274 |
Bitewings - four radiographic images |
186 |
179 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$787.75 |
| D1354 |
|
99 |
39 |
$706.34 |
| D0330 |
Panoramic radiographic image |
72 |
69 |
$679.56 |
| D1330 |
|
417 |
374 |
$0.00 |