| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,875 |
938 |
$672K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,206 |
2,771 |
$553K |
| D1120 |
Prophylaxis - child |
11,790 |
11,339 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
9,516 |
9,287 |
$250K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,933 |
1,565 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,057 |
1,724 |
$244K |
| D1206 |
Topical application of fluoride varnish |
14,004 |
13,469 |
$227K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,651 |
4,241 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,044 |
4,509 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,360 |
3,107 |
$146K |
| D1351 |
Sealant - per tooth |
4,427 |
1,183 |
$124K |
| D1110 |
Prophylaxis - adult |
2,811 |
2,698 |
$107K |
| D9420 |
|
883 |
809 |
$101K |
| D0330 |
Panoramic radiographic image |
1,714 |
1,613 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
5,556 |
5,254 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,676 |
1,579 |
$62K |
| D2929 |
|
367 |
94 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,445 |
1,362 |
$51K |
| D3230 |
|
317 |
87 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,187 |
1,136 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,824 |
1,756 |
$33K |
| D1510 |
|
95 |
60 |
$18K |
| D2934 |
|
96 |
25 |
$18K |
| D0240 |
|
500 |
251 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
67 |
29 |
$5K |
| D2330 |
|
54 |
27 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
123 |
106 |
$2K |