| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,638 |
531 |
$276K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
812 |
397 |
$95K |
| D1120 |
Prophylaxis - child |
1,579 |
1,570 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
597 |
294 |
$73K |
| D9248 |
|
238 |
229 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
634 |
320 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,590 |
1,582 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,834 |
1,822 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
382 |
230 |
$40K |
| D1351 |
Sealant - per tooth |
1,021 |
267 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
528 |
518 |
$36K |
| D0272 |
Bitewings - two radiographic images |
997 |
986 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
409 |
$16K |
| D1330 |
|
1,105 |
1,093 |
$12K |
| D1310 |
|
1,105 |
1,093 |
$12K |
| D1510 |
|
56 |
41 |
$10K |
| D0240 |
|
284 |
283 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
387 |
377 |
$5K |
| D1110 |
Prophylaxis - adult |
92 |
91 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
169 |
166 |
$3K |