| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
886 |
518 |
$108K |
| D1120 |
Prophylaxis - child |
2,856 |
2,832 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,678 |
2,652 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
658 |
448 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,152 |
1,084 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,014 |
1,996 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,275 |
1,265 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
812 |
794 |
$28K |
| D1110 |
Prophylaxis - adult |
438 |
432 |
$19K |
| D0272 |
Bitewings - two radiographic images |
948 |
923 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
367 |
364 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
237 |
127 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,059 |
1,041 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
258 |
252 |
$12K |
| D0330 |
Panoramic radiographic image |
228 |
225 |
$11K |
| D1351 |
Sealant - per tooth |
445 |
149 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
112 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
27 |
$3K |