| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,704 |
884 |
$654K |
| D1120 |
Prophylaxis - child |
9,581 |
8,913 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
8,559 |
7,989 |
$206K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,681 |
1,031 |
$163K |
| D1206 |
Topical application of fluoride varnish |
10,811 |
10,065 |
$157K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,427 |
2,274 |
$101K |
| D1351 |
Sealant - per tooth |
4,202 |
1,285 |
$98K |
| D0272 |
Bitewings - two radiographic images |
4,388 |
4,097 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,759 |
1,611 |
$73K |
| D9420 |
|
606 |
573 |
$69K |
| D2934 |
|
328 |
87 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,640 |
1,921 |
$55K |
| D1110 |
Prophylaxis - adult |
1,516 |
1,413 |
$52K |
| D0330 |
Panoramic radiographic image |
1,061 |
988 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,081 |
2,830 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
171 |
$21K |
| D0274 |
Bitewings - four radiographic images |
556 |
519 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
183 |
101 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
337 |
199 |
$7K |
| D1510 |
|
38 |
31 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
33 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
128 |
$5K |
| D1354 |
|
308 |
107 |
$2K |
| D1353 |
|
289 |
82 |
$0.00 |