| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,496 |
307 |
$129K |
| D1120 |
Prophylaxis - child |
6,164 |
4,501 |
$116K |
| D1206 |
Topical application of fluoride varnish |
4,712 |
3,338 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,102 |
1,935 |
$71K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
849 |
196 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
835 |
409 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,098 |
1,836 |
$44K |
| D0272 |
Bitewings - two radiographic images |
3,866 |
2,779 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,735 |
1,120 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
901 |
682 |
$27K |
| D0330 |
Panoramic radiographic image |
757 |
671 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,306 |
1,029 |
$14K |
| D1351 |
Sealant - per tooth |
466 |
132 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
77 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,030 |
811 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
63 |
$8K |
| D9248 |
|
190 |
133 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
564 |
225 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
73 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
100 |
98 |
$4K |
| D0274 |
Bitewings - four radiographic images |
137 |
131 |
$3K |
| D9420 |
|
93 |
66 |
$0.00 |