| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,398 |
341 |
$269K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,402 |
2,864 |
$111K |
| D1120 |
Prophylaxis - child |
4,852 |
2,956 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,390 |
333 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
2,286 |
1,000 |
$57K |
| D1206 |
Topical application of fluoride varnish |
3,989 |
2,445 |
$56K |
| D0330 |
Panoramic radiographic image |
1,560 |
1,015 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
333 |
154 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,937 |
1,809 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
752 |
373 |
$24K |
| D0350 |
|
640 |
400 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
39 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
997 |
603 |
$8K |
| D9310 |
|
124 |
90 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
244 |
173 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
592 |
183 |
$2K |
| D2330 |
|
23 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
158 |
89 |
$1K |