| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,396 |
994 |
$470K |
| D1120 |
Prophylaxis - child |
6,248 |
6,160 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,104 |
1,093 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,576 |
821 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
3,692 |
3,640 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
2,020 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,240 |
2,098 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,841 |
3,784 |
$82K |
| D1206 |
Topical application of fluoride varnish |
2,834 |
2,793 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,046 |
2,984 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,093 |
1,077 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
733 |
469 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,785 |
2,712 |
$43K |
| D1351 |
Sealant - per tooth |
1,162 |
364 |
$36K |
| D2929 |
|
129 |
31 |
$28K |
| D0330 |
Panoramic radiographic image |
432 |
426 |
$26K |
| D1110 |
Prophylaxis - adult |
499 |
492 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,903 |
1,785 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
397 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
243 |
141 |
$22K |
| D9420 |
|
200 |
184 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,119 |
1,083 |
$16K |
| D2330 |
|
140 |
78 |
$11K |
| D9248 |
|
51 |
46 |
$7K |
| D2934 |
|
38 |
12 |
$6K |
| D1510 |
|
40 |
29 |
$3K |
| D2332 |
|
19 |
14 |
$2K |