| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
981 |
372 |
$121K |
| D1120 |
Prophylaxis - child |
2,959 |
2,921 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,408 |
3,371 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
927 |
438 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
834 |
333 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,518 |
3,479 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,086 |
2,064 |
$42K |
| D1110 |
Prophylaxis - adult |
793 |
788 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
684 |
661 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,674 |
1,620 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
277 |
141 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
298 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
711 |
692 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
833 |
781 |
$10K |
| D9248 |
|
147 |
124 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
70 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
166 |
165 |
$7K |
| D9420 |
|
14 |
14 |
$1K |