| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,855 |
3,267 |
$1.94M |
| D1351 |
Sealant - per tooth |
39,655 |
7,767 |
$1.05M |
| D0145 |
Oral evaluation for a patient under three years of age |
5,067 |
5,051 |
$698K |
| D1120 |
Prophylaxis - child |
19,140 |
19,046 |
$657K |
| D0120 |
Periodic oral evaluation - established patient |
19,674 |
19,580 |
$536K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,502 |
1,832 |
$330K |
| D0210 |
Intraoral - complete series of radiographic images |
4,743 |
4,715 |
$306K |
| D1206 |
Topical application of fluoride varnish |
20,955 |
20,838 |
$291K |
| D0272 |
Bitewings - two radiographic images |
12,731 |
12,664 |
$281K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,102 |
19,210 |
$247K |
| D0220 |
Intraoral - periapical first radiographic image |
20,767 |
20,446 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,099 |
1,736 |
$223K |
| D1110 |
Prophylaxis - adult |
4,354 |
4,328 |
$223K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,769 |
1,213 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,889 |
4,854 |
$158K |
| D2934 |
|
1,019 |
350 |
$142K |
| D9248 |
|
1,309 |
1,283 |
$131K |
| D0274 |
Bitewings - four radiographic images |
3,737 |
3,712 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,055 |
1,282 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,022 |
3,954 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,520 |
2,513 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,382 |
1,358 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
136 |
97 |
$13K |
| D2330 |
|
189 |
102 |
$13K |
| D1510 |
|
30 |
27 |
$4K |
| D7111 |
|
174 |
124 |
$2K |
| D0270 |
|
32 |
32 |
$142.10 |
| D0603 |
|
30,145 |
29,963 |
$0.00 |