| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,579 |
1,006 |
$509K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,099 |
3,059 |
$429K |
| D1351 |
Sealant - per tooth |
11,313 |
2,695 |
$304K |
| D1120 |
Prophylaxis - child |
7,570 |
7,439 |
$267K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,196 |
978 |
$214K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,787 |
7,359 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
6,258 |
6,156 |
$175K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,461 |
9,305 |
$134K |
| D9248 |
|
1,056 |
1,028 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
1,582 |
1,562 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,045 |
2,986 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,119 |
7,966 |
$99K |
| D1110 |
Prophylaxis - adult |
1,460 |
1,441 |
$77K |
| D0272 |
Bitewings - two radiographic images |
3,115 |
3,064 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
698 |
369 |
$52K |
| D0274 |
Bitewings - four radiographic images |
789 |
783 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
399 |
204 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
821 |
799 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
251 |
121 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
199 |
$4K |
| D1510 |
|
17 |
12 |
$3K |
| D0603 |
|
10,260 |
10,072 |
$0.00 |
| D0602 |
|
2,921 |
2,874 |
$0.00 |