| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,944 |
968 |
$463K |
| D1120 |
Prophylaxis - child |
3,676 |
3,381 |
$97K |
| D1351 |
Sealant - per tooth |
4,440 |
1,292 |
$94K |
| D1206 |
Topical application of fluoride varnish |
4,375 |
4,009 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,240 |
2,992 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
824 |
438 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,170 |
1,762 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,049 |
940 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,306 |
1,191 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
241 |
96 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,225 |
1,116 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,165 |
781 |
$10K |
| D1110 |
Prophylaxis - adult |
327 |
320 |
$8K |
| D2140 |
|
314 |
201 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
259 |
239 |
$4K |
| D1354 |
|
49 |
27 |
$3K |
| D2330 |
|
69 |
38 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
27 |
$3K |
| D1510 |
|
55 |
28 |
$2K |
| D0160 |
|
39 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
43 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
53 |
$486.84 |
| D2331 |
|
76 |
47 |
$385.88 |
| D0330 |
Panoramic radiographic image |
59 |
50 |
$322.60 |
| D9920 |
|
47 |
34 |
$90.00 |
| D0603 |
|
839 |
774 |
$0.00 |
| D0601 |
|
34 |
31 |
$0.00 |