| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,852 |
1,017 |
$263K |
| D1120 |
Prophylaxis - child |
5,640 |
5,310 |
$196K |
| D1351 |
Sealant - per tooth |
5,648 |
1,237 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
6,256 |
5,889 |
$143K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,945 |
1,162 |
$133K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,648 |
916 |
$132K |
| D1206 |
Topical application of fluoride varnish |
5,772 |
5,420 |
$127K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,298 |
2,764 |
$97K |
| D1110 |
Prophylaxis - adult |
2,036 |
1,909 |
$93K |
| D0272 |
Bitewings - two radiographic images |
2,443 |
2,312 |
$58K |
| D2140 |
|
909 |
653 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,162 |
1,094 |
$43K |
| D0330 |
Panoramic radiographic image |
646 |
606 |
$37K |
| D0274 |
Bitewings - four radiographic images |
885 |
837 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,168 |
1,103 |
$25K |
| D2331 |
|
88 |
60 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
632 |
583 |
$8K |
| D0240 |
|
393 |
368 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
62 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
44 |
$6K |
| D1510 |
|
28 |
26 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
120 |
116 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
61 |
$2K |
| D0160 |
|
16 |
14 |
$1K |