| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,184 |
1,919 |
$736K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,532 |
4,453 |
$617K |
| D1351 |
Sealant - per tooth |
18,361 |
3,828 |
$497K |
| D1120 |
Prophylaxis - child |
11,362 |
11,312 |
$398K |
| D0120 |
Periodic oral evaluation - established patient |
11,219 |
11,162 |
$309K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,693 |
1,474 |
$246K |
| D0272 |
Bitewings - two radiographic images |
8,682 |
8,627 |
$194K |
| D1206 |
Topical application of fluoride varnish |
11,220 |
11,161 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
2,341 |
2,330 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,079 |
1,357 |
$151K |
| D0220 |
Intraoral - periapical first radiographic image |
12,839 |
12,543 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,342 |
11,512 |
$132K |
| D1110 |
Prophylaxis - adult |
2,081 |
2,062 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,771 |
2,748 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,512 |
3,410 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,498 |
891 |
$85K |
| D0274 |
Bitewings - four radiographic images |
1,963 |
1,946 |
$64K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
764 |
469 |
$61K |
| D9248 |
|
345 |
335 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,085 |
2,066 |
$29K |
| D2332 |
|
183 |
125 |
$23K |
| D0350 |
|
643 |
623 |
$11K |
| D2934 |
|
69 |
19 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
408 |
401 |
$7K |
| D2330 |
|
89 |
54 |
$6K |
| D2933 |
|
35 |
12 |
$5K |
| D1510 |
|
16 |
13 |
$2K |
| D0603 |
|
18,057 |
17,880 |
$0.00 |
| D0601 |
|
158 |
154 |
$0.00 |
| D0602 |
|
121 |
120 |
$0.00 |