| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,388 |
852 |
$213K |
| D1120 |
Prophylaxis - child |
3,263 |
3,218 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,799 |
2,396 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,067 |
3,023 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,603 |
1,578 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,000 |
825 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,049 |
3,008 |
$69K |
| D1110 |
Prophylaxis - adult |
1,215 |
1,192 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,540 |
2,507 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
532 |
432 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,032 |
2,010 |
$57K |
| D1351 |
Sealant - per tooth |
1,494 |
536 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
816 |
809 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
454 |
325 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
293 |
198 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,349 |
1,221 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
563 |
549 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
160 |
$2K |
| D9986 |
|
25 |
25 |
$0.00 |