| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,562 |
1,084 |
$554K |
| D1120 |
Prophylaxis - child |
14,486 |
14,241 |
$379K |
| D1206 |
Topical application of fluoride varnish |
15,883 |
15,604 |
$259K |
| D0120 |
Periodic oral evaluation - established patient |
12,760 |
12,551 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,280 |
1,221 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,623 |
870 |
$126K |
| D1351 |
Sealant - per tooth |
3,545 |
1,062 |
$91K |
| D0272 |
Bitewings - two radiographic images |
4,963 |
4,894 |
$81K |
| D1355 |
|
2,437 |
611 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,170 |
2,065 |
$61K |
| D1354 |
|
4,011 |
1,057 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,672 |
1,631 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
466 |
269 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,173 |
1,146 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
734 |
290 |
$31K |
| D1110 |
Prophylaxis - adult |
785 |
767 |
$30K |
| D0240 |
|
2,485 |
1,330 |
$28K |
| D9630 |
|
1,082 |
1,079 |
$21K |
| D0330 |
Panoramic radiographic image |
454 |
435 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,495 |
1,447 |
$13K |
| D2929 |
|
186 |
39 |
$12K |
| D9420 |
|
411 |
403 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
415 |
406 |
$8K |
| D9310 |
|
42 |
41 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
152 |
148 |
$3K |
| D0274 |
Bitewings - four radiographic images |
100 |
96 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
99 |
$202.20 |
| D1510 |
|
92 |
52 |
$154.00 |