| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,695 |
1,102 |
$449K |
| D1120 |
Prophylaxis - child |
8,323 |
8,163 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,854 |
1,032 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,270 |
1,295 |
$227K |
| D1206 |
Topical application of fluoride varnish |
10,532 |
10,309 |
$213K |
| D1351 |
Sealant - per tooth |
5,305 |
1,793 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
7,257 |
7,154 |
$175K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,246 |
510 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,012 |
611 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,473 |
2,344 |
$94K |
| D1110 |
Prophylaxis - adult |
1,832 |
1,792 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,021 |
1,939 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,285 |
2,150 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,028 |
2,942 |
$63K |
| D0330 |
Panoramic radiographic image |
1,122 |
1,113 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,650 |
1,608 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,032 |
2,943 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
452 |
448 |
$15K |
| D9110 |
|
253 |
252 |
$14K |
| D0160 |
|
178 |
170 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
243 |
$8K |
| D2929 |
|
47 |
12 |
$6K |
| D0240 |
|
104 |
102 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
92 |
$3K |
| D9420 |
|
16 |
14 |
$2K |