| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,465 |
337 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,416 |
398 |
$109K |
| D1120 |
Prophylaxis - child |
4,540 |
4,135 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
5,478 |
5,013 |
$89K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,425 |
314 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,059 |
5,545 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,419 |
528 |
$61K |
| D1999 |
|
3,546 |
3,155 |
$57K |
| D1110 |
Prophylaxis - adult |
1,694 |
1,555 |
$52K |
| D0272 |
Bitewings - two radiographic images |
3,558 |
3,231 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,711 |
1,497 |
$32K |
| D0330 |
Panoramic radiographic image |
831 |
730 |
$26K |
| D1351 |
Sealant - per tooth |
1,057 |
302 |
$20K |
| D2394 |
|
261 |
107 |
$19K |
| D7961 |
|
145 |
127 |
$18K |
| D2932 |
|
165 |
49 |
$14K |
| D2335 |
|
144 |
39 |
$11K |
| D0274 |
Bitewings - four radiographic images |
734 |
683 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
711 |
623 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
137 |
$3K |
| D7962 |
|
18 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$713.00 |