| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,677 |
702 |
$346K |
| D1120 |
Prophylaxis - child |
6,169 |
5,284 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,184 |
649 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,621 |
807 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,847 |
2,828 |
$119K |
| D1206 |
Topical application of fluoride varnish |
3,894 |
3,783 |
$96K |
| D0330 |
Panoramic radiographic image |
1,568 |
1,368 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,704 |
1,620 |
$58K |
| D1351 |
Sealant - per tooth |
2,118 |
360 |
$58K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
638 |
335 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
3,085 |
2,181 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,191 |
2,690 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
619 |
375 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,596 |
1,351 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,077 |
1,492 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
465 |
426 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
269 |
269 |
$18K |
| D9248 |
|
249 |
243 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
922 |
878 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
196 |
188 |
$7K |
| D2934 |
|
36 |
12 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
26 |
$6K |
| D1110 |
Prophylaxis - adult |
180 |
60 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
117 |
$2K |
| D2330 |
|
17 |
13 |
$1K |
| D0603 |
|
1,872 |
1,641 |
$0.00 |