| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,926 |
833 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,648 |
1,322 |
$129K |
| D1120 |
Prophylaxis - child |
4,738 |
4,556 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
5,007 |
4,843 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,588 |
5,371 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,558 |
1,014 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,238 |
781 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
775 |
496 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,685 |
1,612 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,461 |
1,378 |
$37K |
| D0272 |
Bitewings - two radiographic images |
3,426 |
3,303 |
$33K |
| D1351 |
Sealant - per tooth |
1,494 |
493 |
$31K |
| D0330 |
Panoramic radiographic image |
699 |
654 |
$30K |
| D1110 |
Prophylaxis - adult |
926 |
889 |
$30K |
| D1510 |
|
176 |
151 |
$20K |
| D0240 |
|
1,817 |
767 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
270 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
561 |
545 |
$12K |
| D2330 |
|
203 |
127 |
$10K |
| D0274 |
Bitewings - four radiographic images |
520 |
508 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
705 |
679 |
$3K |
| D2335 |
|
30 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
485 |
468 |
$2K |
| D2331 |
|
13 |
12 |
$698.39 |