| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,258 |
712 |
$256K |
| D1120 |
Prophylaxis - child |
6,976 |
6,924 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
7,815 |
7,755 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,668 |
4,640 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,644 |
1,041 |
$97K |
| D1206 |
Topical application of fluoride varnish |
4,085 |
4,048 |
$88K |
| D1110 |
Prophylaxis - adult |
1,983 |
1,960 |
$84K |
| D1351 |
Sealant - per tooth |
2,700 |
844 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,307 |
2,240 |
$67K |
| D0272 |
Bitewings - two radiographic images |
3,293 |
3,273 |
$58K |
| D0330 |
Panoramic radiographic image |
1,186 |
1,175 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,389 |
2,341 |
$29K |
| D0274 |
Bitewings - four radiographic images |
976 |
965 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
367 |
176 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
836 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
258 |
141 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
340 |
181 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
173 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
654 |
648 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,404 |
1,190 |
$13K |
| D9248 |
|
148 |
136 |
$12K |
| D2332 |
|
17 |
12 |
$2K |