| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,613 |
1,317 |
$524K |
| D0210 |
Intraoral - complete series of radiographic images |
3,786 |
3,592 |
$214K |
| D1120 |
Prophylaxis - child |
6,821 |
6,480 |
$199K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,614 |
1,126 |
$143K |
| D9248 |
|
1,036 |
1,010 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,206 |
3,990 |
$118K |
| D1206 |
Topical application of fluoride varnish |
6,634 |
6,293 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,873 |
4,623 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,365 |
1,284 |
$70K |
| D7111 |
|
922 |
403 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,970 |
1,902 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,245 |
2,129 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
910 |
868 |
$23K |
| D1351 |
Sealant - per tooth |
1,034 |
320 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
296 |
155 |
$18K |
| D0330 |
Panoramic radiographic image |
371 |
355 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
28 |
$2K |
| D2330 |
|
41 |
25 |
$2K |
| D1354 |
|
31 |
13 |
$278.72 |
| D0220 |
Intraoral - periapical first radiographic image |
23 |
23 |
$257.72 |