| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,756 |
1,068 |
$184K |
| D1120 |
Prophylaxis - child |
2,328 |
2,227 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,452 |
913 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,086 |
1,850 |
$66K |
| D1206 |
Topical application of fluoride varnish |
1,957 |
1,868 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
759 |
505 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,770 |
1,698 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
935 |
623 |
$47K |
| D1351 |
Sealant - per tooth |
630 |
359 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,563 |
1,504 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,435 |
2,491 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,974 |
2,787 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,372 |
1,309 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
160 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
327 |
312 |
$8K |
| D0330 |
Panoramic radiographic image |
338 |
328 |
$8K |
| D1354 |
|
319 |
125 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
76 |
$1K |
| D9310 |
|
57 |
50 |
$855.00 |
| D9110 |
|
13 |
13 |
$715.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$219.70 |
| D1999 |
|
13 |
13 |
$0.00 |