| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,732 |
619 |
$240K |
| D2140 |
|
2,305 |
1,279 |
$149K |
| D1120 |
Prophylaxis - child |
4,252 |
4,036 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
5,447 |
5,214 |
$142K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,672 |
1,011 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,608 |
5,364 |
$109K |
| D0272 |
Bitewings - two radiographic images |
3,961 |
3,783 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,234 |
696 |
$88K |
| D1110 |
Prophylaxis - adult |
1,818 |
1,748 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,845 |
2,631 |
$73K |
| D1351 |
Sealant - per tooth |
2,014 |
640 |
$56K |
| D9248 |
|
548 |
504 |
$52K |
| D0330 |
Panoramic radiographic image |
762 |
736 |
$45K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
532 |
321 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,423 |
1,312 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
356 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
710 |
658 |
$10K |
| D0603 |
|
1,638 |
1,583 |
$8K |
| D0601 |
|
1,113 |
1,086 |
$5K |
| D2330 |
|
72 |
55 |
$5K |
| D0602 |
|
765 |
753 |
$4K |
| D1510 |
|
15 |
13 |
$3K |