| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,471 |
1,392 |
$921K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,162 |
4,072 |
$567K |
| D1351 |
Sealant - per tooth |
12,175 |
3,300 |
$321K |
| D1120 |
Prophylaxis - child |
7,901 |
7,835 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
7,022 |
6,969 |
$192K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,559 |
10,406 |
$161K |
| D0272 |
Bitewings - two radiographic images |
7,631 |
7,538 |
$152K |
| D0220 |
Intraoral - periapical first radiographic image |
11,688 |
11,431 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,791 |
1,190 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,362 |
948 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,513 |
3,484 |
$115K |
| D1206 |
Topical application of fluoride varnish |
7,683 |
7,638 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,391 |
2,269 |
$62K |
| D1110 |
Prophylaxis - adult |
967 |
961 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
807 |
381 |
$48K |
| D9420 |
|
705 |
696 |
$25K |
| D2934 |
|
139 |
44 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
911 |
900 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
266 |
266 |
$16K |
| D0330 |
Panoramic radiographic image |
796 |
792 |
$11K |
| D0350 |
|
655 |
649 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
402 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
12 |
$1K |
| D0270 |
|
115 |
115 |
$509.01 |
| D1999 |
|
4,477 |
4,251 |
$0.00 |
| D0603 |
|
15,110 |
14,861 |
$0.00 |