| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
289 |
247 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
519 |
487 |
$35K |
| D1120 |
Prophylaxis - child |
718 |
714 |
$30K |
| D1206 |
Topical application of fluoride varnish |
672 |
670 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
194 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
197 |
175 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
555 |
553 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
149 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
299 |
296 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
704 |
573 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
810 |
802 |
$5K |
| D9310 |
|
297 |
297 |
$5K |
| D1351 |
Sealant - per tooth |
50 |
46 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
30 |
$1K |
| D0274 |
Bitewings - four radiographic images |
54 |
53 |
$1K |
| D0272 |
Bitewings - two radiographic images |
85 |
85 |
$839.88 |
| D0140 |
Limited oral evaluation - problem focused |
36 |
36 |
$688.32 |
| D1354 |
|
17 |
13 |
$445.50 |