| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,158 |
992 |
$237K |
| D1120 |
Prophylaxis - child |
6,396 |
6,120 |
$214K |
| D1206 |
Topical application of fluoride varnish |
8,174 |
7,817 |
$174K |
| D1351 |
Sealant - per tooth |
5,007 |
1,428 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
6,530 |
6,227 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,405 |
915 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,521 |
748 |
$96K |
| D1110 |
Prophylaxis - adult |
1,951 |
1,872 |
$84K |
| D0330 |
Panoramic radiographic image |
2,421 |
2,335 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
670 |
415 |
$54K |
| D9248 |
|
624 |
568 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,728 |
1,609 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,748 |
2,645 |
$45K |
| D1353 |
|
1,565 |
490 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,371 |
1,322 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,502 |
1,445 |
$38K |
| D1510 |
|
206 |
157 |
$30K |
| D2929 |
|
256 |
93 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
461 |
379 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,707 |
1,607 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
643 |
631 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,040 |
259 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
137 |
$3K |
| D2330 |
|
18 |
15 |
$999.30 |
| D1354 |
|
66 |
14 |
$654.06 |
| D2920 |
|
14 |
13 |
$594.32 |