| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,242 |
799 |
$458K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,549 |
1,538 |
$206K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,196 |
644 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,734 |
960 |
$161K |
| D1351 |
Sealant - per tooth |
5,715 |
1,488 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,926 |
1,144 |
$139K |
| D1120 |
Prophylaxis - child |
3,577 |
3,508 |
$122K |
| D0272 |
Bitewings - two radiographic images |
4,144 |
4,048 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,228 |
3,168 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
6,117 |
5,942 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,007 |
1,952 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,082 |
5,296 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,033 |
3,972 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,606 |
1,497 |
$40K |
| D9248 |
|
321 |
315 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
553 |
328 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
56 |
53 |
$32K |
| D1110 |
Prophylaxis - adult |
526 |
515 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
742 |
719 |
$13K |
| D0274 |
Bitewings - four radiographic images |
402 |
395 |
$12K |
| D2934 |
|
79 |
26 |
$12K |
| D1510 |
|
55 |
39 |
$8K |
| D0330 |
Panoramic radiographic image |
176 |
170 |
$7K |
| D2330 |
|
58 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
213 |
197 |
$2K |
| D0270 |
|
481 |
468 |
$2K |
| D0160 |
|
163 |
162 |
$2K |
| D0170 |
|
139 |
138 |
$2K |
| D2950 |
|
32 |
30 |
$1K |
| D7111 |
|
33 |
26 |
$344.10 |
| D0460 |
|
13 |
13 |
$147.00 |
| D0603 |
|
8,216 |
8,013 |
$0.00 |