| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
622 |
251 |
$63K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
460 |
204 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
102 |
$13K |
| D1120 |
Prophylaxis - child |
405 |
397 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
348 |
334 |
$10K |
| D2140 |
|
152 |
110 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
348 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
329 |
328 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
112 |
$3K |
| D0272 |
Bitewings - two radiographic images |
181 |
180 |
$3K |
| D2330 |
|
34 |
17 |
$2K |
| D1206 |
Topical application of fluoride varnish |
62 |
58 |
$840.50 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$634.40 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
28 |
$329.68 |