| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,325 |
297 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,621 |
1,784 |
$80K |
| D1351 |
Sealant - per tooth |
3,310 |
638 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
692 |
343 |
$66K |
| D1120 |
Prophylaxis - child |
2,639 |
2,116 |
$60K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
465 |
165 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,293 |
1,276 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
737 |
639 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,851 |
1,808 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
368 |
$24K |
| D1110 |
Prophylaxis - adult |
551 |
515 |
$19K |
| D0330 |
Panoramic radiographic image |
645 |
422 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,190 |
900 |
$15K |
| D0240 |
|
1,341 |
462 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
988 |
850 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
207 |
89 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
79 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,073 |
591 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,019 |
290 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
25 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
141 |
$5K |
| D0274 |
Bitewings - four radiographic images |
216 |
209 |
$5K |
| D0351 |
|
12 |
12 |
$0.00 |