| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,647 |
1,006 |
$301K |
| D1120 |
Prophylaxis - child |
11,070 |
10,677 |
$271K |
| D1206 |
Topical application of fluoride varnish |
10,977 |
10,596 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
8,239 |
7,938 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,576 |
1,467 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,796 |
3,680 |
$107K |
| D1351 |
Sealant - per tooth |
3,759 |
1,340 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,417 |
983 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,685 |
2,377 |
$78K |
| D0272 |
Bitewings - two radiographic images |
4,372 |
4,229 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
693 |
381 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,307 |
1,238 |
$35K |
| D0330 |
Panoramic radiographic image |
653 |
630 |
$35K |
| D0240 |
|
2,461 |
1,190 |
$30K |
| D1110 |
Prophylaxis - adult |
457 |
443 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
337 |
180 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
272 |
156 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
172 |
87 |
$10K |
| D0274 |
Bitewings - four radiographic images |
290 |
286 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
967 |
893 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
44 |
$4K |
| D2335 |
|
23 |
12 |
$2K |
| D1354 |
|
101 |
45 |
$2K |
| D2140 |
|
32 |
24 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
21 |
14 |
$504.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
30 |
$245.00 |
| D9420 |
|
16 |
16 |
$0.00 |
| D1999 |
|
59 |
49 |
$0.00 |
| D9987 |
|
41 |
41 |
$0.00 |
| D9986 |
|
45 |
45 |
$0.00 |