| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,442 |
1,185 |
$592K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,177 |
2,902 |
$455K |
| D1120 |
Prophylaxis - child |
11,296 |
11,150 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
11,347 |
11,213 |
$300K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,855 |
5,659 |
$272K |
| D1351 |
Sealant - per tooth |
7,110 |
2,460 |
$201K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,184 |
11,056 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,162 |
1,637 |
$176K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,870 |
904 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,316 |
1,241 |
$143K |
| D2390 |
|
896 |
264 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
7,270 |
7,063 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,571 |
5,977 |
$102K |
| D0272 |
Bitewings - two radiographic images |
5,305 |
5,180 |
$92K |
| D0330 |
Panoramic radiographic image |
1,540 |
1,521 |
$85K |
| D9420 |
|
781 |
640 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,397 |
1,358 |
$63K |
| D1110 |
Prophylaxis - adult |
1,171 |
1,147 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
184 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
536 |
530 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,427 |
1,354 |
$17K |
| D0274 |
Bitewings - four radiographic images |
388 |
381 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
12 |
$6K |
| D2330 |
|
81 |
51 |
$5K |
| D1354 |
|
203 |
84 |
$1K |