| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,274 |
802 |
$157K |
| D1120 |
Prophylaxis - child |
3,748 |
3,558 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,119 |
1,961 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,933 |
2,781 |
$80K |
| D1206 |
Topical application of fluoride varnish |
2,952 |
2,848 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,074 |
1,005 |
$23K |
| D1351 |
Sealant - per tooth |
485 |
216 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,268 |
2,121 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
387 |
258 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
343 |
267 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
695 |
598 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,081 |
1,934 |
$13K |
| D2140 |
|
375 |
279 |
$12K |
| D0274 |
Bitewings - four radiographic images |
629 |
604 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,536 |
1,384 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
117 |
85 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
274 |
$5K |
| D0330 |
Panoramic radiographic image |
89 |
85 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
51 |
$729.00 |
| D1999 |
|
145 |
116 |
$0.00 |