| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,367 |
712 |
$388K |
| D1120 |
Prophylaxis - child |
8,443 |
8,347 |
$245K |
| D1351 |
Sealant - per tooth |
7,568 |
1,636 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
7,444 |
7,371 |
$157K |
| D0272 |
Bitewings - two radiographic images |
6,531 |
6,466 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,708 |
1,057 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,365 |
707 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,493 |
969 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,284 |
5,231 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,752 |
3,683 |
$64K |
| D0330 |
Panoramic radiographic image |
991 |
985 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,272 |
2,109 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,548 |
1,529 |
$45K |
| D2934 |
|
258 |
77 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
529 |
251 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,584 |
2,512 |
$31K |
| D1510 |
|
201 |
144 |
$29K |
| D9420 |
|
386 |
382 |
$27K |
| D1110 |
Prophylaxis - adult |
565 |
554 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,921 |
1,343 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
408 |
$12K |
| D2330 |
|
125 |
72 |
$7K |
| D0274 |
Bitewings - four radiographic images |
158 |
155 |
$4K |
| D2331 |
|
49 |
42 |
$4K |
| D2332 |
|
37 |
25 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$399.62 |