| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,564 |
663 |
$136K |
| D1120 |
Prophylaxis - child |
3,830 |
3,529 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,208 |
564 |
$55K |
| D1999 |
|
2,753 |
2,346 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
3,044 |
2,802 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
767 |
484 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,771 |
3,459 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,973 |
1,711 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,675 |
1,512 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
462 |
336 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,159 |
1,986 |
$33K |
| D1351 |
Sealant - per tooth |
923 |
331 |
$17K |
| D1206 |
Topical application of fluoride varnish |
742 |
703 |
$17K |
| D0330 |
Panoramic radiographic image |
359 |
332 |
$15K |
| D1110 |
Prophylaxis - adult |
419 |
386 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
330 |
294 |
$9K |
| D0240 |
|
456 |
332 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
676 |
554 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
215 |
199 |
$5K |
| D0274 |
Bitewings - four radiographic images |
125 |
112 |
$3K |
| D2331 |
|
34 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
256 |
84 |
$2K |
| D1330 |
|
4,686 |
4,316 |
$0.00 |