| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,655 |
1,090 |
$393K |
| D9248 |
|
1,393 |
1,330 |
$136K |
| D1120 |
Prophylaxis - child |
4,783 |
4,623 |
$99K |
| D1351 |
Sealant - per tooth |
5,927 |
1,702 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
4,932 |
4,818 |
$75K |
| D1206 |
Topical application of fluoride varnish |
5,630 |
5,475 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,233 |
684 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,501 |
653 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,128 |
666 |
$48K |
| D2932 |
|
368 |
148 |
$42K |
| D1110 |
Prophylaxis - adult |
1,498 |
1,459 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
943 |
899 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
755 |
729 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,471 |
2,408 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,486 |
1,403 |
$29K |
| D2330 |
|
551 |
322 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
445 |
299 |
$20K |
| D2331 |
|
388 |
230 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
793 |
740 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
568 |
556 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$562.00 |
| D0274 |
Bitewings - four radiographic images |
32 |
30 |
$529.30 |