| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,751 |
604 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,298 |
563 |
$154K |
| D1120 |
Prophylaxis - child |
2,123 |
2,113 |
$109K |
| D7140 |
Extraction, erupted tooth or exposed root |
953 |
406 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,097 |
2,086 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
490 |
262 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,409 |
2,393 |
$58K |
| D9248 |
|
187 |
183 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
503 |
330 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
688 |
671 |
$46K |
| D1351 |
Sealant - per tooth |
932 |
262 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,349 |
1,341 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
550 |
$22K |
| D1330 |
|
1,435 |
1,422 |
$16K |
| D1310 |
|
1,437 |
1,424 |
$16K |
| D0240 |
|
432 |
428 |
$15K |
| D2934 |
|
54 |
17 |
$13K |
| D1110 |
Prophylaxis - adult |
150 |
149 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
484 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
275 |
272 |
$5K |
| D1510 |
|
18 |
16 |
$4K |