| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
337 |
83 |
$41K |
| D1120 |
Prophylaxis - child |
397 |
397 |
$12K |
| D1206 |
Topical application of fluoride varnish |
512 |
509 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
32 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
336 |
336 |
$8K |
| D9420 |
|
45 |
45 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
108 |
$4K |
| D0272 |
Bitewings - two radiographic images |
151 |
151 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
83 |
83 |
$3K |
| D1110 |
Prophylaxis - adult |
56 |
56 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
177 |
173 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
53 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
37 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
36 |
$1K |
| D0240 |
|
37 |
37 |
$937.90 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$365.82 |