| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,604 |
898 |
$509K |
| D1120 |
Prophylaxis - child |
9,365 |
8,952 |
$253K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,271 |
915 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
6,489 |
6,280 |
$168K |
| D1206 |
Topical application of fluoride varnish |
9,738 |
9,320 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,490 |
3,222 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,340 |
2,099 |
$102K |
| D9420 |
|
822 |
745 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,167 |
625 |
$91K |
| D1351 |
Sealant - per tooth |
3,652 |
965 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,356 |
665 |
$88K |
| D0272 |
Bitewings - two radiographic images |
4,172 |
3,954 |
$65K |
| D0240 |
|
2,496 |
1,280 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,337 |
2,213 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,113 |
1,251 |
$25K |
| D0330 |
Panoramic radiographic image |
539 |
491 |
$19K |
| D1110 |
Prophylaxis - adult |
413 |
380 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
323 |
$13K |
| D0160 |
|
141 |
138 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
220 |
206 |
$8K |
| D9248 |
|
344 |
331 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
88 |
38 |
$7K |
| D2932 |
|
29 |
12 |
$5K |
| D0274 |
Bitewings - four radiographic images |
127 |
127 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
190 |
167 |
$3K |
| D2330 |
|
28 |
13 |
$2K |
| D1354 |
|
345 |
102 |
$2K |
| D0270 |
|
35 |
35 |
$124.60 |