| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,793 |
497 |
$212K |
| D1120 |
Prophylaxis - child |
3,736 |
3,668 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,250 |
707 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,057 |
3,987 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,002 |
2,948 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
930 |
515 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
688 |
324 |
$54K |
| D1351 |
Sealant - per tooth |
1,942 |
715 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,607 |
1,549 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,021 |
1,987 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
663 |
430 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
463 |
453 |
$27K |
| D0274 |
Bitewings - four radiographic images |
859 |
849 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
779 |
737 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,354 |
1,329 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
419 |
414 |
$15K |
| D1110 |
Prophylaxis - adult |
411 |
406 |
$15K |
| D2330 |
|
180 |
92 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
104 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,067 |
974 |
$11K |
| D2929 |
|
88 |
25 |
$11K |
| D2331 |
|
108 |
76 |
$9K |
| D0240 |
|
370 |
263 |
$6K |
| D9420 |
|
64 |
59 |
$5K |
| D1510 |
|
31 |
27 |
$4K |
| D2940 |
|
17 |
14 |
$683.18 |