| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,899 |
1,661 |
$507K |
| D1120 |
Prophylaxis - child |
9,509 |
9,509 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,707 |
1,485 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
10,550 |
10,550 |
$248K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,538 |
1,855 |
$219K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,295 |
5,957 |
$205K |
| D1206 |
Topical application of fluoride varnish |
12,408 |
12,408 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,857 |
1,308 |
$196K |
| D1110 |
Prophylaxis - adult |
3,377 |
3,377 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
6,966 |
6,832 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,941 |
3,714 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
860 |
504 |
$72K |
| D9248 |
|
950 |
921 |
$67K |
| D0272 |
Bitewings - two radiographic images |
3,535 |
3,535 |
$67K |
| D1351 |
Sealant - per tooth |
1,785 |
695 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
991 |
991 |
$41K |
| D0330 |
Panoramic radiographic image |
696 |
696 |
$35K |
| D9310 |
|
533 |
533 |
$34K |
| D0145 |
Oral evaluation for a patient under three years of age |
837 |
837 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
743 |
740 |
$29K |
| D0240 |
|
1,691 |
1,069 |
$27K |
| D0274 |
Bitewings - four radiographic images |
944 |
944 |
$26K |