| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,775 |
1,784 |
$972K |
| D1120 |
Prophylaxis - child |
13,591 |
13,385 |
$427K |
| D0120 |
Periodic oral evaluation - established patient |
15,272 |
15,012 |
$355K |
| D1206 |
Topical application of fluoride varnish |
17,673 |
17,352 |
$306K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,629 |
1,545 |
$239K |
| D0272 |
Bitewings - two radiographic images |
10,193 |
10,010 |
$207K |
| D1351 |
Sealant - per tooth |
4,509 |
1,367 |
$112K |
| D1110 |
Prophylaxis - adult |
1,914 |
1,899 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,365 |
2,287 |
$71K |
| D0240 |
|
3,439 |
3,041 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,470 |
2,380 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,853 |
1,847 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
423 |
256 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
302 |
204 |
$28K |
| D0330 |
Panoramic radiographic image |
748 |
741 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
194 |
$19K |
| D0350 |
|
749 |
724 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
156 |
151 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
71 |
$2K |
| D0270 |
|
42 |
41 |
$394.93 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
31 |
$312.04 |