| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,531 |
1,648 |
$1.03M |
| D1120 |
Prophylaxis - child |
15,540 |
14,468 |
$623K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,645 |
2,317 |
$563K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,954 |
1,781 |
$410K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,115 |
14,069 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
11,140 |
10,381 |
$342K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,345 |
4,036 |
$249K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,493 |
3,226 |
$189K |
| D1351 |
Sealant - per tooth |
5,351 |
1,614 |
$187K |
| D0330 |
Panoramic radiographic image |
2,966 |
2,717 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,939 |
1,148 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
3,697 |
3,417 |
$159K |
| D0272 |
Bitewings - two radiographic images |
4,948 |
4,664 |
$140K |
| D0274 |
Bitewings - four radiographic images |
3,231 |
2,983 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
3,351 |
3,056 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,358 |
1,884 |
$36K |
| D2330 |
|
148 |
82 |
$14K |
| D9420 |
|
104 |
94 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
49 |
$9K |
| D1206 |
Topical application of fluoride varnish |
16 |
15 |
$198.94 |
| D9430 |
|
12 |
12 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
45 |
44 |
$0.00 |