| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9248 |
|
6,153 |
5,444 |
$448K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,058 |
1,909 |
$399K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,094 |
1,980 |
$329K |
| D1120 |
Prophylaxis - child |
9,151 |
9,151 |
$321K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,001 |
1,623 |
$307K |
| D0120 |
Periodic oral evaluation - established patient |
8,938 |
8,938 |
$211K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,492 |
11,492 |
$189K |
| D0272 |
Bitewings - two radiographic images |
9,308 |
9,308 |
$177K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,077 |
4,540 |
$166K |
| D1110 |
Prophylaxis - adult |
2,339 |
2,339 |
$118K |
| D0240 |
|
4,995 |
2,666 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
1,986 |
1,983 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,531 |
1,531 |
$64K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
658 |
478 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
796 |
796 |
$39K |
| D0330 |
Panoramic radiographic image |
436 |
436 |
$16K |
| D2934 |
|
118 |
50 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
385 |
383 |
$5K |
| D2330 |
|
46 |
40 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
40 |
$5K |