| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,776 |
665 |
$257K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,673 |
1,670 |
$233K |
| D1120 |
Prophylaxis - child |
4,760 |
4,741 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
5,157 |
5,140 |
$147K |
| D0272 |
Bitewings - two radiographic images |
5,282 |
5,255 |
$121K |
| D1351 |
Sealant - per tooth |
4,316 |
957 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
7,685 |
7,257 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,665 |
5,643 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
800 |
621 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,422 |
5,731 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
760 |
543 |
$58K |
| D1110 |
Prophylaxis - adult |
902 |
898 |
$48K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
523 |
221 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,168 |
1,118 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
353 |
346 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
136 |
$3K |
| D0603 |
|
7,462 |
7,424 |
$0.00 |