| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,254 |
2,149 |
$563K |
| D1120 |
Prophylaxis - child |
16,271 |
15,887 |
$472K |
| D1351 |
Sealant - per tooth |
16,006 |
3,233 |
$372K |
| D0120 |
Periodic oral evaluation - established patient |
17,498 |
17,095 |
$357K |
| D1206 |
Topical application of fluoride varnish |
14,670 |
14,318 |
$257K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,832 |
1,874 |
$241K |
| D1110 |
Prophylaxis - adult |
4,034 |
3,973 |
$166K |
| D0272 |
Bitewings - two radiographic images |
6,802 |
6,636 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,659 |
1,263 |
$109K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,077 |
4,449 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,380 |
5,290 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,486 |
917 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,447 |
2,405 |
$64K |
| D0330 |
Panoramic radiographic image |
1,808 |
1,759 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,382 |
1,360 |
$40K |
| D1354 |
|
6,709 |
1,932 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
698 |
681 |
$37K |
| D9310 |
|
1,202 |
1,182 |
$37K |
| D0240 |
|
2,387 |
1,391 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,076 |
1,059 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,592 |
2,479 |
$28K |
| D1353 |
|
843 |
202 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
175 |
55 |
$10K |
| D9420 |
|
261 |
244 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
342 |
333 |
$9K |
| D2934 |
|
74 |
19 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,288 |
560 |
$8K |