| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,947 |
1,859 |
$552K |
| D0120 |
Periodic oral evaluation - established patient |
19,591 |
18,998 |
$504K |
| D1120 |
Prophylaxis - child |
18,373 |
17,701 |
$491K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,151 |
2,795 |
$430K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,277 |
18,623 |
$318K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,715 |
4,381 |
$204K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,575 |
1,375 |
$157K |
| D1110 |
Prophylaxis - adult |
3,964 |
3,863 |
$151K |
| D0272 |
Bitewings - two radiographic images |
8,148 |
7,866 |
$146K |
| D1351 |
Sealant - per tooth |
5,245 |
1,482 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
9,156 |
8,551 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,601 |
1,135 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,794 |
2,613 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
2,308 |
2,187 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,625 |
4,364 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,001 |
1,946 |
$64K |
| D0330 |
Panoramic radiographic image |
1,103 |
1,050 |
$59K |
| D0240 |
|
2,705 |
1,507 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,613 |
2,508 |
$41K |
| D2335 |
|
213 |
156 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
101 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
172 |
108 |
$13K |
| D9420 |
|
39 |
38 |
$5K |