| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,796 |
631 |
$537K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,616 |
1,608 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,126 |
5,031 |
$191K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,856 |
414 |
$148K |
| D1120 |
Prophylaxis - child |
3,650 |
3,630 |
$131K |
| D1351 |
Sealant - per tooth |
3,410 |
614 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,060 |
3,043 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
876 |
294 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
5,563 |
5,515 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,445 |
4,418 |
$64K |
| D0272 |
Bitewings - two radiographic images |
1,870 |
1,860 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,224 |
1,214 |
$42K |
| D2934 |
|
236 |
58 |
$33K |
| D9248 |
|
264 |
254 |
$29K |
| D1110 |
Prophylaxis - adult |
390 |
387 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
257 |
106 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
78 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
368 |
$7K |
| D0160 |
|
315 |
314 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
54 |
54 |
$1K |
| D0274 |
Bitewings - four radiographic images |
29 |
29 |
$1K |
| D0601 |
|
3,878 |
3,864 |
$0.03 |
| D0603 |
|
1,092 |
1,078 |
$0.00 |
| D0602 |
|
607 |
602 |
$0.00 |