| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
418 |
137 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,061 |
2,014 |
$54K |
| D1120 |
Prophylaxis - child |
1,156 |
1,116 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,048 |
2,001 |
$40K |
| D1110 |
Prophylaxis - adult |
767 |
761 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,511 |
1,482 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
207 |
86 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
83 |
$12K |
| D2140 |
|
160 |
121 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
379 |
350 |
$10K |
| D1351 |
Sealant - per tooth |
321 |
84 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
97 |
78 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
40 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
177 |
154 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
28 |
$1K |