| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,859 |
376 |
$310K |
| D1120 |
Prophylaxis - child |
5,617 |
5,539 |
$122K |
| D1206 |
Topical application of fluoride varnish |
7,256 |
7,139 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,744 |
1,070 |
$86K |
| D1351 |
Sealant - per tooth |
5,713 |
1,300 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
5,018 |
4,982 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
614 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
813 |
370 |
$54K |
| D9420 |
|
224 |
222 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
832 |
821 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
2,223 |
2,130 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,679 |
2,654 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
719 |
690 |
$28K |
| D1110 |
Prophylaxis - adult |
989 |
983 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,188 |
3,035 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,714 |
1,673 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
982 |
965 |
$20K |
| D0274 |
Bitewings - four radiographic images |
947 |
941 |
$16K |
| D1354 |
|
1,351 |
223 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
189 |
$8K |
| D0240 |
|
559 |
359 |
$7K |
| D2330 |
|
46 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$2K |
| D0160 |
|
27 |
27 |
$1K |
| D1999 |
|
807 |
767 |
$0.00 |
| D3120 |
|
363 |
235 |
$0.00 |
| D1310 |
|
950 |
936 |
$0.00 |
| D1330 |
|
954 |
940 |
$0.00 |