| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,998 |
1,301 |
$791K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,454 |
1,662 |
$298K |
| D1120 |
Prophylaxis - child |
4,818 |
4,688 |
$233K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,291 |
750 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,290 |
3,221 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,475 |
5,311 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,372 |
579 |
$74K |
| D9420 |
|
1,195 |
1,146 |
$71K |
| D0272 |
Bitewings - two radiographic images |
3,980 |
3,789 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
3,082 |
2,965 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
888 |
384 |
$56K |
| D0330 |
Panoramic radiographic image |
1,270 |
1,235 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,955 |
2,799 |
$31K |
| D1110 |
Prophylaxis - adult |
551 |
525 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,804 |
2,573 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
715 |
603 |
$19K |
| D0274 |
Bitewings - four radiographic images |
596 |
578 |
$17K |
| D1510 |
|
30 |
25 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
142 |
$5K |