| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,397 |
840 |
$351K |
| D1120 |
Prophylaxis - child |
3,292 |
3,078 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
589 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
886 |
510 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
812 |
412 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,495 |
2,353 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,017 |
1,925 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,555 |
1,378 |
$50K |
| D1351 |
Sealant - per tooth |
1,532 |
630 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,642 |
1,550 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,088 |
1,003 |
$46K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
223 |
133 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
272 |
257 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
325 |
$8K |
| D9420 |
|
25 |
25 |
$5K |
| D0330 |
Panoramic radiographic image |
57 |
55 |
$4K |