| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,779 |
706 |
$396K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,504 |
6,356 |
$240K |
| D1120 |
Prophylaxis - child |
11,650 |
9,839 |
$236K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,318 |
678 |
$183K |
| D1206 |
Topical application of fluoride varnish |
9,220 |
8,328 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,726 |
692 |
$158K |
| D2934 |
|
551 |
131 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
941 |
397 |
$71K |
| D1351 |
Sealant - per tooth |
2,924 |
529 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,011 |
457 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
4,946 |
3,333 |
$57K |
| D0330 |
Panoramic radiographic image |
1,161 |
1,107 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,326 |
2,800 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,465 |
1,193 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
959 |
858 |
$32K |
| D9310 |
|
545 |
502 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,283 |
2,068 |
$22K |
| D1110 |
Prophylaxis - adult |
368 |
272 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
70 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
358 |
341 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
215 |
194 |
$2K |