| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,337 |
399 |
$301K |
| D1120 |
Prophylaxis - child |
3,254 |
3,136 |
$92K |
| D1354 |
|
2,861 |
916 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,451 |
3,333 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,810 |
2,689 |
$40K |
| D1999 |
|
2,100 |
1,954 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,518 |
1,449 |
$27K |
| D1206 |
Topical application of fluoride varnish |
888 |
864 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
571 |
539 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
50 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
101 |
$5K |
| D0330 |
Panoramic radiographic image |
102 |
99 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
245 |
66 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
53 |
$1K |
| D1110 |
Prophylaxis - adult |
29 |
27 |
$939.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$220.00 |