| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
549 |
194 |
$58K |
| D1120 |
Prophylaxis - child |
1,190 |
1,145 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,217 |
1,169 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,103 |
1,073 |
$17K |
| D0272 |
Bitewings - two radiographic images |
541 |
524 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
314 |
297 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
123 |
52 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
208 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
357 |
333 |
$5K |
| D9248 |
|
86 |
80 |
$5K |
| D9110 |
|
30 |
29 |
$805.36 |
| D1110 |
Prophylaxis - adult |
14 |
13 |
$668.50 |
| D9630 |
|
25 |
25 |
$0.00 |