| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,255 |
1,201 |
$697K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,889 |
2,325 |
$366K |
| D0120 |
Periodic oral evaluation - established patient |
10,923 |
10,742 |
$301K |
| D1120 |
Prophylaxis - child |
8,455 |
8,294 |
$287K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,216 |
2,035 |
$215K |
| D1110 |
Prophylaxis - adult |
3,762 |
3,704 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,942 |
4,629 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,918 |
7,787 |
$158K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,536 |
670 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,394 |
2,693 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,209 |
1,178 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,262 |
3,219 |
$69K |
| D7111 |
|
1,160 |
603 |
$69K |
| D1206 |
Topical application of fluoride varnish |
2,910 |
2,844 |
$65K |
| D0330 |
Panoramic radiographic image |
1,152 |
1,131 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,542 |
4,325 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,067 |
1,047 |
$48K |
| D9420 |
|
513 |
480 |
$42K |
| D0145 |
Oral evaluation for a patient under three years of age |
615 |
610 |
$29K |
| D1351 |
Sealant - per tooth |
555 |
141 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,193 |
1,156 |
$17K |
| D2390 |
|
79 |
26 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
38 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
24 |
$2K |
| D2330 |
|
13 |
12 |
$992.12 |
| D9110 |
|
26 |
13 |
$58.67 |