| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,948 |
758 |
$315K |
| D1120 |
Prophylaxis - child |
4,464 |
4,374 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,230 |
6,966 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,076 |
3,845 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,990 |
3,894 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
5,802 |
5,479 |
$61K |
| D2335 |
|
502 |
163 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,988 |
1,812 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
929 |
326 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,484 |
2,376 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,454 |
1,378 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
542 |
225 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
564 |
293 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
407 |
218 |
$24K |
| D1999 |
|
903 |
817 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
436 |
$16K |
| D0330 |
Panoramic radiographic image |
174 |
168 |
$9K |
| D1351 |
Sealant - per tooth |
270 |
77 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
123 |
$3K |
| D1510 |
|
16 |
13 |
$3K |
| D2330 |
|
22 |
14 |
$1K |
| D9420 |
|
638 |
601 |
$0.00 |