| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,679 |
1,395 |
$648K |
| D9310 |
|
2,145 |
2,084 |
$104K |
| D9248 |
|
644 |
612 |
$82K |
| D1120 |
Prophylaxis - child |
2,697 |
2,636 |
$72K |
| D7961 |
|
402 |
323 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
826 |
401 |
$50K |
| D2934 |
|
321 |
89 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,472 |
2,411 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,757 |
2,694 |
$41K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
441 |
217 |
$38K |
| D7962 |
|
159 |
159 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,234 |
2,147 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,882 |
1,825 |
$32K |
| D1351 |
Sealant - per tooth |
1,150 |
407 |
$24K |
| D0240 |
|
679 |
679 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
307 |
306 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
33 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
181 |
172 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
51 |
$3K |
| D0330 |
Panoramic radiographic image |
85 |
85 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$762.25 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$731.76 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$503.03 |