| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,786 |
966 |
$619K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,181 |
689 |
$128K |
| D0240 |
|
2,580 |
774 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
553 |
471 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,081 |
1,055 |
$58K |
| D1510 |
|
166 |
143 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,121 |
1,063 |
$36K |
| D1120 |
Prophylaxis - child |
654 |
615 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
226 |
218 |
$27K |
| D0330 |
Panoramic radiographic image |
254 |
244 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
663 |
601 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
120 |
$22K |
| D1206 |
Topical application of fluoride varnish |
705 |
659 |
$21K |
| D0470 |
|
236 |
228 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
118 |
98 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
30 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
59 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
48 |
$1K |
| D1110 |
Prophylaxis - adult |
14 |
12 |
$213.68 |