| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,638 |
629 |
$347K |
| D1120 |
Prophylaxis - child |
7,361 |
7,102 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
4,564 |
4,411 |
$119K |
| D1206 |
Topical application of fluoride varnish |
7,689 |
7,417 |
$118K |
| D0603 |
|
6,579 |
6,361 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,336 |
616 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,123 |
2,030 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
694 |
298 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,506 |
1,363 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,815 |
2,674 |
$42K |
| D1351 |
Sealant - per tooth |
1,795 |
498 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,170 |
1,151 |
$38K |
| D0330 |
Panoramic radiographic image |
829 |
798 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,366 |
1,237 |
$28K |
| D1110 |
Prophylaxis - adult |
774 |
749 |
$27K |
| D0240 |
|
1,868 |
988 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,084 |
1,933 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
122 |
57 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
393 |
$15K |
| D1354 |
|
700 |
327 |
$14K |
| D0602 |
|
800 |
777 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
245 |
138 |
$11K |
| D0274 |
Bitewings - four radiographic images |
533 |
514 |
$11K |
| D9310 |
|
131 |
127 |
$8K |
| D0601 |
|
171 |
166 |
$3K |
| D1330 |
|
3,930 |
3,744 |
$0.10 |
| D1310 |
|
3,916 |
3,735 |
$0.00 |
| D3120 |
|
134 |
70 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
16 |
15 |
$0.00 |
| D1320 |
|
23 |
19 |
$0.00 |
| D1999 |
|
487 |
410 |
$0.00 |