| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,312 |
938 |
$412K |
| D1120 |
Prophylaxis - child |
11,555 |
11,122 |
$289K |
| D1206 |
Topical application of fluoride varnish |
12,660 |
12,172 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
11,108 |
10,662 |
$195K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,267 |
386 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,556 |
3,179 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,650 |
764 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,341 |
863 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,715 |
3,577 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,035 |
1,334 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,773 |
3,523 |
$36K |
| D1110 |
Prophylaxis - adult |
1,113 |
1,058 |
$29K |
| D1351 |
Sealant - per tooth |
1,324 |
442 |
$27K |
| D0330 |
Panoramic radiographic image |
735 |
698 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,537 |
1,479 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
626 |
445 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
428 |
406 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
290 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
165 |
165 |
$4K |
| D7962 |
|
12 |
12 |
$2K |
| D1354 |
|
369 |
143 |
$2K |
| D9248 |
|
30 |
25 |
$2K |
| D1999 |
|
6,369 |
5,806 |
$0.00 |