| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,134 |
1,557 |
$482K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,669 |
1,135 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,867 |
980 |
$151K |
| D1120 |
Prophylaxis - child |
5,734 |
5,416 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,288 |
1,117 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
6,004 |
5,702 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,736 |
5,454 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,408 |
1,324 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,566 |
2,358 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,698 |
1,601 |
$32K |
| D1351 |
Sealant - per tooth |
1,435 |
389 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,223 |
1,110 |
$28K |
| D1110 |
Prophylaxis - adult |
750 |
710 |
$27K |
| D9248 |
|
705 |
576 |
$23K |
| D9920 |
|
795 |
697 |
$19K |
| D0330 |
Panoramic radiographic image |
271 |
256 |
$11K |
| D1510 |
|
72 |
36 |
$7K |
| D1206 |
Topical application of fluoride varnish |
511 |
482 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
740 |
668 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
566 |
184 |
$4K |
| D1354 |
|
50 |
24 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
63 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
12 |
$986.69 |
| D0274 |
Bitewings - four radiographic images |
30 |
27 |
$984.76 |