| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,158 |
642 |
$213K |
| D1120 |
Prophylaxis - child |
5,147 |
5,045 |
$148K |
| D1206 |
Topical application of fluoride varnish |
5,188 |
5,082 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
4,384 |
4,302 |
$87K |
| D1351 |
Sealant - per tooth |
2,216 |
669 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,252 |
2,208 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
647 |
353 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,615 |
2,520 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,858 |
1,970 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
284 |
$24K |
| D0330 |
Panoramic radiographic image |
589 |
571 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
787 |
766 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
249 |
151 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,039 |
995 |
$19K |
| D1110 |
Prophylaxis - adult |
326 |
323 |
$12K |
| D0274 |
Bitewings - four radiographic images |
191 |
189 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
112 |
$3K |
| D9310 |
|
92 |
90 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
69 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
13 |
$1K |