| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,810 |
775 |
$540K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,450 |
1,421 |
$196K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,333 |
624 |
$187K |
| D1351 |
Sealant - per tooth |
5,498 |
1,195 |
$142K |
| D1120 |
Prophylaxis - child |
3,365 |
3,305 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,799 |
2,745 |
$76K |
| D0272 |
Bitewings - two radiographic images |
3,446 |
3,324 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,611 |
4,934 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,029 |
1,979 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,758 |
5,592 |
$65K |
| D9248 |
|
569 |
561 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,775 |
3,706 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
449 |
252 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
546 |
276 |
$32K |
| D1110 |
Prophylaxis - adult |
483 |
472 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
887 |
827 |
$22K |
| D0274 |
Bitewings - four radiographic images |
418 |
407 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
94 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
489 |
480 |
$9K |
| D1206 |
Topical application of fluoride varnish |
307 |
298 |
$4K |
| D2931 |
|
14 |
12 |
$2K |
| D2950 |
|
32 |
29 |
$1K |
| D0160 |
|
33 |
33 |
$463.45 |
| D0270 |
|
113 |
110 |
$435.12 |
| D0603 |
|
7,278 |
7,135 |
$0.00 |