| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,210 |
1,223 |
$955K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,102 |
1,012 |
$368K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,739 |
1,582 |
$100K |
| D1120 |
Prophylaxis - child |
3,590 |
3,255 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,239 |
2,031 |
$40K |
| D1206 |
Topical application of fluoride varnish |
4,027 |
3,643 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,472 |
1,317 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
2,994 |
2,780 |
$19K |
| D0330 |
Panoramic radiographic image |
299 |
276 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,056 |
867 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
168 |
143 |
$4K |
| D1351 |
Sealant - per tooth |
131 |
39 |
$2K |
| D0603 |
|
2,899 |
2,683 |
$437.00 |
| D0601 |
|
210 |
203 |
$60.00 |
| D0602 |
|
350 |
344 |
$30.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
31 |
$0.00 |