| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,460 |
1,929 |
$777K |
| D1120 |
Prophylaxis - child |
30,917 |
27,938 |
$730K |
| D0120 |
Periodic oral evaluation - established patient |
33,446 |
30,170 |
$580K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,973 |
31,270 |
$462K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,326 |
3,302 |
$357K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,831 |
3,193 |
$329K |
| D1999 |
|
16,884 |
14,259 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,655 |
2,374 |
$282K |
| D1110 |
Prophylaxis - adult |
6,903 |
6,155 |
$224K |
| D0272 |
Bitewings - two radiographic images |
12,128 |
10,440 |
$180K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,901 |
8,383 |
$174K |
| D0140 |
Limited oral evaluation - problem focused |
6,447 |
5,548 |
$148K |
| D0330 |
Panoramic radiographic image |
3,560 |
3,153 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,008 |
4,325 |
$107K |
| D1206 |
Topical application of fluoride varnish |
4,350 |
3,899 |
$100K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,026 |
748 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
8,123 |
6,267 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,512 |
2,529 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,344 |
2,067 |
$47K |
| D2330 |
|
1,115 |
436 |
$38K |
| D1351 |
Sealant - per tooth |
1,368 |
339 |
$26K |
| D2331 |
|
351 |
167 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
466 |
370 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
132 |
$6K |
| D3120 |
|
84 |
39 |
$336.00 |
| D9420 |
|
259 |
144 |
$0.00 |