| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,616 |
538 |
$240K |
| D1120 |
Prophylaxis - child |
4,435 |
3,928 |
$207K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,533 |
850 |
$153K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,636 |
666 |
$130K |
| D1206 |
Topical application of fluoride varnish |
5,249 |
4,646 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,730 |
3,348 |
$102K |
| D1351 |
Sealant - per tooth |
2,771 |
772 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,472 |
1,320 |
$77K |
| D8670 |
Periodic orthodontic treatment visit |
262 |
250 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
571 |
376 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,345 |
2,072 |
$64K |
| D2335 |
|
405 |
160 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
791 |
327 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,305 |
1,089 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,960 |
1,604 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,914 |
1,632 |
$33K |
| D1110 |
Prophylaxis - adult |
491 |
443 |
$29K |
| D3120 |
|
829 |
488 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,310 |
1,091 |
$27K |
| D0274 |
Bitewings - four radiographic images |
576 |
517 |
$23K |
| D0330 |
Panoramic radiographic image |
288 |
255 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
349 |
296 |
$8K |
| D8660 |
|
41 |
39 |
$5K |
| D9310 |
|
73 |
71 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$2K |