| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,866 |
897 |
$184K |
| D1120 |
Prophylaxis - child |
8,816 |
8,522 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
8,334 |
8,056 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,593 |
2,008 |
$140K |
| D1206 |
Topical application of fluoride varnish |
7,404 |
7,167 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,240 |
1,704 |
$115K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,696 |
906 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,510 |
1,007 |
$85K |
| D0272 |
Bitewings - two radiographic images |
4,644 |
4,511 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,360 |
1,326 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,651 |
1,589 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,033 |
1,946 |
$29K |
| D1110 |
Prophylaxis - adult |
863 |
839 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
4,505 |
4,325 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,119 |
3,759 |
$21K |
| D2933 |
|
41 |
12 |
$6K |
| D2330 |
|
101 |
67 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
87 |
65 |
$5K |
| D2140 |
|
76 |
59 |
$3K |
| D2331 |
|
31 |
25 |
$2K |