| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,947 |
1,057 |
$549K |
| D1120 |
Prophylaxis - child |
9,315 |
8,344 |
$276K |
| D1354 |
|
4,545 |
1,194 |
$269K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,427 |
1,429 |
$259K |
| D1206 |
Topical application of fluoride varnish |
10,392 |
9,315 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
7,495 |
6,751 |
$157K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,549 |
3,770 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,746 |
1,171 |
$114K |
| D1351 |
Sealant - per tooth |
4,630 |
1,015 |
$114K |
| D0272 |
Bitewings - two radiographic images |
5,384 |
4,792 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,512 |
1,036 |
$79K |
| D0240 |
|
6,120 |
2,690 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,054 |
1,806 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,967 |
1,815 |
$58K |
| D1110 |
Prophylaxis - adult |
1,062 |
1,001 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,612 |
2,342 |
$27K |
| D0330 |
Panoramic radiographic image |
587 |
521 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,201 |
1,288 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
496 |
390 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
361 |
343 |
$12K |
| D0274 |
Bitewings - four radiographic images |
345 |
327 |
$10K |
| D1355 |
|
129 |
33 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34 |
12 |
$3K |
| D2330 |
|
16 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
13 |
$367.71 |
| D1330 |
|
38 |
35 |
$0.00 |