| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,609 |
2,005 |
$904K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,184 |
6,072 |
$839K |
| D1120 |
Prophylaxis - child |
22,021 |
21,613 |
$764K |
| D0120 |
Periodic oral evaluation - established patient |
21,822 |
21,417 |
$602K |
| D1351 |
Sealant - per tooth |
14,972 |
3,326 |
$384K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,460 |
20,196 |
$288K |
| D0272 |
Bitewings - two radiographic images |
12,150 |
11,879 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,289 |
1,344 |
$159K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,262 |
5,056 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,022 |
2,916 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,031 |
551 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,665 |
794 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
5,923 |
5,646 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,665 |
3,885 |
$48K |
| D0330 |
Panoramic radiographic image |
1,061 |
1,054 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,720 |
2,546 |
$37K |
| D1110 |
Prophylaxis - adult |
494 |
484 |
$25K |
| D2933 |
|
45 |
12 |
$6K |
| D9420 |
|
168 |
166 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
272 |
$5K |
| D0274 |
Bitewings - four radiographic images |
117 |
117 |
$4K |
| D0602 |
|
7,977 |
7,821 |
$0.00 |
| D0603 |
|
24,347 |
23,841 |
$0.00 |
| D0601 |
|
361 |
358 |
$0.00 |