| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,757 |
459 |
$172K |
| D1120 |
Prophylaxis - child |
4,297 |
4,239 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
4,049 |
3,978 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
976 |
443 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,595 |
2,537 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,885 |
2,827 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,530 |
2,491 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
729 |
708 |
$29K |
| D2933 |
|
164 |
46 |
$24K |
| D1110 |
Prophylaxis - adult |
617 |
605 |
$24K |
| D2934 |
|
183 |
45 |
$21K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
303 |
167 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
848 |
842 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
205 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
288 |
206 |
$14K |
| D0240 |
|
1,035 |
823 |
$13K |
| D1330 |
|
1,826 |
1,822 |
$9K |
| D1354 |
|
962 |
412 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
961 |
938 |
$8K |
| D1351 |
Sealant - per tooth |
476 |
137 |
$7K |
| D0330 |
Panoramic radiographic image |
139 |
132 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
189 |
188 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
387 |
278 |
$3K |
| D1310 |
|
116 |
116 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$689.93 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$663.00 |
| D1999 |
|
37 |
36 |
$0.00 |