| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
801 |
142 |
$70K |
| D1120 |
Prophylaxis - child |
2,683 |
2,551 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,491 |
2,373 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,621 |
1,569 |
$38K |
| D1999 |
|
2,243 |
1,977 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,090 |
1,004 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,163 |
1,076 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
379 |
361 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
441 |
401 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
304 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
922 |
863 |
$9K |
| D0240 |
|
630 |
290 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
57 |
$9K |
| D0330 |
Panoramic radiographic image |
158 |
154 |
$7K |
| D1110 |
Prophylaxis - adult |
101 |
100 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
400 |
174 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
29 |
$3K |
| D0274 |
Bitewings - four radiographic images |
28 |
28 |
$554.40 |