| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,251 |
2,489 |
$499K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,602 |
3,395 |
$484K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,791 |
1,556 |
$359K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,176 |
1,937 |
$266K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,424 |
6,552 |
$240K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,888 |
1,600 |
$239K |
| D1120 |
Prophylaxis - child |
5,102 |
5,102 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
5,304 |
5,304 |
$124K |
| D0272 |
Bitewings - two radiographic images |
5,808 |
5,808 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,570 |
6,570 |
$108K |
| D1110 |
Prophylaxis - adult |
1,641 |
1,641 |
$82K |
| D0240 |
|
3,273 |
2,676 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,131 |
3,942 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,069 |
1,069 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,088 |
1,716 |
$33K |
| D1510 |
|
105 |
82 |
$18K |
| D9920 |
|
313 |
300 |
$16K |
| D9310 |
|
119 |
119 |
$7K |
| D0330 |
Panoramic radiographic image |
146 |
146 |
$7K |
| D7111 |
|
97 |
65 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
115 |
$4K |
| D2332 |
|
18 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$1K |