| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,545 |
2,038 |
$451K |
| D1120 |
Prophylaxis - child |
6,533 |
6,283 |
$265K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,417 |
3,994 |
$197K |
| D1206 |
Topical application of fluoride varnish |
5,854 |
5,634 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
5,077 |
4,882 |
$142K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,563 |
1,256 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,330 |
966 |
$78K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,046 |
770 |
$74K |
| D1351 |
Sealant - per tooth |
1,378 |
719 |
$70K |
| D2140 |
|
1,316 |
1,105 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,229 |
2,114 |
$50K |
| D0272 |
Bitewings - two radiographic images |
4,095 |
3,913 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,470 |
1,421 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,796 |
3,610 |
$23K |
| D0330 |
Panoramic radiographic image |
641 |
630 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,959 |
2,706 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
580 |
544 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
687 |
628 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
82 |
$2K |
| D1999 |
|
602 |
425 |
$0.00 |
| D9920 |
|
14 |
12 |
$0.00 |