| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,670 |
788 |
$294K |
| D1120 |
Prophylaxis - child |
8,013 |
7,953 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
9,155 |
9,087 |
$226K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,351 |
1,407 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,558 |
5,504 |
$118K |
| D1351 |
Sealant - per tooth |
3,808 |
1,199 |
$117K |
| D1206 |
Topical application of fluoride varnish |
4,606 |
4,575 |
$99K |
| D1110 |
Prophylaxis - adult |
2,286 |
2,257 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,978 |
2,928 |
$87K |
| D0272 |
Bitewings - two radiographic images |
3,714 |
3,677 |
$65K |
| D0330 |
Panoramic radiographic image |
1,229 |
1,220 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
984 |
479 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
608 |
372 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
450 |
208 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
454 |
218 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
955 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,053 |
1,031 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,068 |
2,027 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
763 |
752 |
$17K |
| D9248 |
|
203 |
188 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,223 |
1,110 |
$11K |
| D2332 |
|
71 |
38 |
$6K |