| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,659 |
1,071 |
$626K |
| D1120 |
Prophylaxis - child |
13,569 |
13,283 |
$418K |
| D1206 |
Topical application of fluoride varnish |
16,319 |
15,983 |
$320K |
| D0120 |
Periodic oral evaluation - established patient |
14,043 |
13,777 |
$318K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,568 |
1,023 |
$158K |
| D0272 |
Bitewings - two radiographic images |
8,777 |
8,645 |
$151K |
| D0330 |
Panoramic radiographic image |
3,346 |
3,285 |
$133K |
| D1110 |
Prophylaxis - adult |
2,754 |
2,710 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,827 |
2,785 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,294 |
827 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
697 |
295 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
2,358 |
2,265 |
$52K |
| D1351 |
Sealant - per tooth |
2,057 |
618 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,755 |
1,709 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,237 |
3,115 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,183 |
1,149 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
83 |
$8K |
| D9110 |
|
151 |
150 |
$6K |