| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,677 |
1,721 |
$640K |
| D1120 |
Prophylaxis - child |
8,993 |
8,375 |
$237K |
| D1206 |
Topical application of fluoride varnish |
10,502 |
9,752 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
9,067 |
8,467 |
$160K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,731 |
873 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,556 |
1,584 |
$125K |
| D0272 |
Bitewings - two radiographic images |
6,462 |
5,948 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,807 |
1,833 |
$110K |
| D1351 |
Sealant - per tooth |
4,222 |
1,358 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,821 |
906 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,029 |
3,415 |
$91K |
| D1110 |
Prophylaxis - adult |
1,525 |
1,415 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,152 |
1,972 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,508 |
1,194 |
$43K |
| D0240 |
|
2,402 |
1,807 |
$32K |
| D1354 |
|
333 |
103 |
$27K |
| D0330 |
Panoramic radiographic image |
656 |
594 |
$25K |
| D2390 |
|
426 |
177 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,635 |
1,447 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
582 |
527 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
295 |
268 |
$7K |
| D0274 |
Bitewings - four radiographic images |
279 |
255 |
$7K |
| D0270 |
|
401 |
365 |
$6K |
| D2330 |
|
54 |
37 |
$2K |
| D2332 |
|
22 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
238 |
132 |
$1K |
| D9430 |
|
75 |
68 |
$0.00 |