| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,321 |
752 |
$322K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,174 |
1,898 |
$299K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,581 |
1,540 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
6,540 |
6,325 |
$177K |
| D1120 |
Prophylaxis - child |
4,868 |
4,707 |
$166K |
| D9248 |
|
1,725 |
1,625 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,586 |
1,069 |
$117K |
| D0272 |
Bitewings - two radiographic images |
5,351 |
5,169 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,562 |
1,059 |
$109K |
| D1351 |
Sealant - per tooth |
4,259 |
1,157 |
$109K |
| D1110 |
Prophylaxis - adult |
2,037 |
1,982 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,979 |
6,755 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
5,851 |
5,643 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,665 |
5,414 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,091 |
1,935 |
$53K |
| D0330 |
Panoramic radiographic image |
988 |
952 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
419 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
92 |
$10K |
| D9420 |
|
56 |
53 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
76 |
76 |
$1K |
| D0603 |
|
3,585 |
3,522 |
$0.00 |
| D0602 |
|
5,222 |
5,144 |
$0.00 |