| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,501 |
2,251 |
$1.33M |
| D1120 |
Prophylaxis - child |
14,227 |
14,033 |
$480K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,908 |
2,407 |
$337K |
| D9920 |
|
4,622 |
4,546 |
$320K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,070 |
12,895 |
$274K |
| D0120 |
Periodic oral evaluation - established patient |
9,933 |
9,797 |
$201K |
| D9310 |
|
1,652 |
1,630 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,854 |
1,069 |
$139K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,471 |
775 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,791 |
3,762 |
$119K |
| D2929 |
|
617 |
203 |
$114K |
| D0272 |
Bitewings - two radiographic images |
4,660 |
4,609 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
890 |
529 |
$79K |
| D1351 |
Sealant - per tooth |
2,003 |
808 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,746 |
1,691 |
$60K |
| D0240 |
|
3,596 |
2,691 |
$44K |
| D2330 |
|
503 |
280 |
$40K |
| D0330 |
Panoramic radiographic image |
679 |
666 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,878 |
1,846 |
$39K |
| D2331 |
|
343 |
187 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,128 |
1,091 |
$29K |
| D0274 |
Bitewings - four radiographic images |
905 |
905 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
748 |
728 |
$8K |
| D1510 |
|
51 |
36 |
$7K |