| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,031 |
1,245 |
$984K |
| D9420 |
|
1,056 |
1,026 |
$196K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,835 |
1,301 |
$190K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,132 |
1,150 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,299 |
2,824 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,862 |
1,125 |
$96K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
969 |
466 |
$83K |
| D1351 |
Sealant - per tooth |
3,424 |
1,126 |
$79K |
| D1120 |
Prophylaxis - child |
3,091 |
2,998 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,779 |
2,674 |
$60K |
| D1206 |
Topical application of fluoride varnish |
3,151 |
3,058 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,156 |
1,121 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,923 |
1,868 |
$31K |
| D0240 |
|
1,820 |
960 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,867 |
1,812 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
283 |
$13K |
| D1510 |
|
37 |
27 |
$5K |
| D2331 |
|
50 |
27 |
$4K |
| D2330 |
|
42 |
24 |
$3K |
| D0274 |
Bitewings - four radiographic images |
49 |
47 |
$448.87 |
| D1354 |
|
71 |
12 |
$433.26 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$339.41 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$56.63 |