| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
554 |
161 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
611 |
551 |
$24K |
| D1120 |
Prophylaxis - child |
675 |
624 |
$24K |
| D1206 |
Topical application of fluoride varnish |
832 |
758 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
397 |
360 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
280 |
242 |
$13K |
| D0272 |
Bitewings - two radiographic images |
640 |
587 |
$12K |
| D0240 |
|
927 |
397 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
46 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
83 |
37 |
$9K |
| D9420 |
|
28 |
24 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
170 |
164 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
314 |
284 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
16 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
32 |
$1K |