| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,194 |
682 |
$275K |
| D1120 |
Prophylaxis - child |
5,019 |
5,014 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
5,091 |
5,085 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,030 |
892 |
$120K |
| D1110 |
Prophylaxis - adult |
2,070 |
2,065 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,950 |
2,518 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,269 |
4,263 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,250 |
882 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,470 |
3,440 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,466 |
1,432 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,032 |
4,758 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
910 |
896 |
$47K |
| D9420 |
|
485 |
438 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,676 |
1,676 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,415 |
3,447 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
301 |
214 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,789 |
1,758 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
252 |
122 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
258 |
258 |
$10K |