| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,103 |
1,929 |
$123K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
810 |
389 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
2,306 |
2,241 |
$104K |
| D1206 |
Topical application of fluoride varnish |
2,039 |
1,986 |
$50K |
| D1120 |
Prophylaxis - child |
2,130 |
2,048 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
708 |
427 |
$44K |
| D0999 |
Unspecified diagnostic procedure, by report |
1,319 |
1,181 |
$42K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
242 |
173 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
353 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
675 |
583 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
391 |
336 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
156 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,203 |
1,139 |
$7K |
| D2330 |
|
83 |
57 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
531 |
476 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
92 |
80 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
420 |
315 |
$2K |
| D2335 |
|
17 |
13 |
$2K |
| D9310 |
|
55 |
55 |
$1K |
| D1351 |
Sealant - per tooth |
12 |
12 |
$0.00 |
| CHTRV |
|
12 |
12 |
$0.00 |
| T1099 |
|
18 |
16 |
$0.00 |