| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,011 |
1,043 |
$315K |
| D1120 |
Prophylaxis - child |
4,719 |
4,622 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,894 |
806 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,165 |
631 |
$89K |
| D1206 |
Topical application of fluoride varnish |
5,029 |
4,922 |
$85K |
| D1351 |
Sealant - per tooth |
3,498 |
1,050 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,015 |
619 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,773 |
2,725 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,835 |
1,777 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,878 |
1,615 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,123 |
2,071 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,375 |
2,269 |
$26K |
| D0240 |
|
1,782 |
935 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
687 |
681 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,005 |
1,874 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
417 |
400 |
$12K |
| D2330 |
|
221 |
124 |
$11K |
| D9310 |
|
319 |
317 |
$10K |
| D2331 |
|
151 |
95 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
153 |
94 |
$10K |
| D9420 |
|
257 |
252 |
$10K |
| D1110 |
Prophylaxis - adult |
234 |
228 |
$9K |
| D0330 |
Panoramic radiographic image |
192 |
186 |
$5K |
| D2390 |
|
58 |
26 |
$5K |
| D0274 |
Bitewings - four radiographic images |
158 |
154 |
$4K |
| D1354 |
|
237 |
100 |
$2K |
| D1330 |
|
31 |
31 |
$0.00 |