| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
626 |
105 |
$87K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
188 |
60 |
$16K |
| D2140 |
|
222 |
104 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
64 |
$10K |
| D1120 |
Prophylaxis - child |
251 |
239 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
334 |
321 |
$9K |
| D0272 |
Bitewings - two radiographic images |
318 |
307 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
331 |
318 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
354 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
353 |
321 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
131 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
131 |
122 |
$3K |
| D1110 |
Prophylaxis - adult |
53 |
53 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$2K |
| D0603 |
|
183 |
175 |
$860.00 |
| D0602 |
|
34 |
33 |
$140.00 |