| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
11,112 |
1,413 |
$811K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,464 |
402 |
$181K |
| D2941 |
|
505 |
172 |
$75K |
| D1120 |
Prophylaxis - child |
2,198 |
1,942 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,535 |
2,234 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
661 |
254 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,115 |
962 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,035 |
853 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,152 |
1,026 |
$20K |
| D0272 |
Bitewings - two radiographic images |
793 |
682 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
291 |
137 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
145 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,213 |
1,001 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
286 |
262 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
150 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,009 |
438 |
$7K |
| D1110 |
Prophylaxis - adult |
103 |
91 |
$3K |
| D1351 |
Sealant - per tooth |
76 |
13 |
$2K |
| D2931 |
|
22 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
58 |
53 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
14 |
$516.16 |
| D0240 |
|
24 |
16 |
$388.50 |
| D1330 |
|
406 |
341 |
$0.00 |
| D0603 |
|
2,337 |
2,025 |
$0.00 |
| D9420 |
|
228 |
185 |
$0.00 |
| D1310 |
|
365 |
301 |
$0.00 |
| D0171 |
|
28 |
25 |
$0.00 |
| D0350 |
|
356 |
290 |
$0.00 |