| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9248 |
|
2,030 |
1,855 |
$322K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,614 |
971 |
$309K |
| D1120 |
Prophylaxis - child |
7,534 |
7,217 |
$248K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,081 |
1,167 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
7,987 |
7,686 |
$187K |
| D1206 |
Topical application of fluoride varnish |
9,306 |
8,925 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,671 |
784 |
$121K |
| D0272 |
Bitewings - two radiographic images |
4,630 |
4,416 |
$102K |
| D1351 |
Sealant - per tooth |
3,122 |
750 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
893 |
470 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,204 |
2,908 |
$73K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,257 |
569 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,059 |
1,990 |
$66K |
| D0240 |
|
1,877 |
1,721 |
$35K |
| D1110 |
Prophylaxis - adult |
386 |
371 |
$17K |
| D0274 |
Bitewings - four radiographic images |
272 |
258 |
$8K |
| D0330 |
Panoramic radiographic image |
126 |
119 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
94 |
$3K |
| D2332 |
|
26 |
12 |
$3K |
| D2331 |
|
22 |
15 |
$1K |