| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
938 |
272 |
$102K |
| D1120 |
Prophylaxis - child |
3,279 |
3,159 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,580 |
4,394 |
$65K |
| D1999 |
|
3,490 |
2,900 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
3,038 |
2,965 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
732 |
424 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,602 |
1,367 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,180 |
1,093 |
$29K |
| D0330 |
Panoramic radiographic image |
612 |
586 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,579 |
1,503 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
392 |
211 |
$23K |
| D1110 |
Prophylaxis - adult |
442 |
431 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
118 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
899 |
835 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
258 |
245 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
288 |
101 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
103 |
97 |
$2K |
| D0274 |
Bitewings - four radiographic images |
96 |
90 |
$2K |
| D1206 |
Topical application of fluoride varnish |
72 |
72 |
$2K |