| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,826 |
1,337 |
$242K |
| D1120 |
Prophylaxis - child |
8,953 |
8,749 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
12,145 |
11,876 |
$211K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,732 |
13,355 |
$196K |
| D0330 |
Panoramic radiographic image |
2,733 |
2,660 |
$122K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,124 |
1,393 |
$122K |
| D1110 |
Prophylaxis - adult |
3,062 |
2,982 |
$102K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,083 |
639 |
$85K |
| D0272 |
Bitewings - two radiographic images |
4,753 |
4,608 |
$80K |
| D1351 |
Sealant - per tooth |
2,317 |
738 |
$57K |
| D2140 |
|
1,235 |
925 |
$57K |
| D2160 |
|
783 |
551 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
806 |
534 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,716 |
1,665 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,840 |
1,769 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,935 |
1,883 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
602 |
574 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
504 |
489 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
350 |
337 |
$9K |
| D3120 |
|
370 |
258 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
78 |
$810.00 |