| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,395 |
1,575 |
$671K |
| D1120 |
Prophylaxis - child |
11,214 |
11,163 |
$386K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,768 |
2,589 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
13,267 |
13,206 |
$306K |
| D1206 |
Topical application of fluoride varnish |
15,791 |
15,717 |
$257K |
| D1110 |
Prophylaxis - adult |
4,506 |
4,486 |
$224K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,544 |
1,761 |
$201K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,929 |
5,739 |
$184K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,471 |
834 |
$135K |
| D0272 |
Bitewings - two radiographic images |
6,699 |
6,670 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
2,925 |
2,882 |
$111K |
| D0330 |
Panoramic radiographic image |
2,150 |
2,148 |
$102K |
| D1351 |
Sealant - per tooth |
3,062 |
1,167 |
$89K |
| D9248 |
|
995 |
980 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,251 |
1,244 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,325 |
1,321 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,909 |
1,897 |
$52K |
| D0240 |
|
2,228 |
1,265 |
$42K |
| D9420 |
|
389 |
387 |
$33K |
| D9920 |
|
445 |
440 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,563 |
1,549 |
$20K |
| D2330 |
|
260 |
144 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
215 |
104 |
$17K |
| D9310 |
|
198 |
198 |
$13K |
| D2934 |
|
38 |
12 |
$5K |
| D2331 |
|
21 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114 |
79 |
$1K |