| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
612 |
148 |
$77K |
| D1120 |
Prophylaxis - child |
978 |
883 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
115 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,386 |
1,243 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
958 |
850 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
99 |
$17K |
| D1351 |
Sealant - per tooth |
479 |
136 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
57 |
$11K |
| D9420 |
|
94 |
72 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
339 |
292 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
214 |
$9K |
| D1110 |
Prophylaxis - adult |
201 |
180 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
254 |
211 |
$8K |
| D0272 |
Bitewings - two radiographic images |
396 |
356 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
163 |
$6K |
| D0240 |
|
215 |
191 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
443 |
379 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
147 |
140 |
$5K |
| D0330 |
Panoramic radiographic image |
55 |
54 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
96 |
$2K |
| D2941 |
|
30 |
16 |
$2K |
| D0274 |
Bitewings - four radiographic images |
36 |
35 |
$1K |