| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,297 |
1,519 |
$755K |
| D1120 |
Prophylaxis - child |
19,675 |
19,430 |
$694K |
| D0120 |
Periodic oral evaluation - established patient |
23,911 |
23,639 |
$667K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,687 |
4,582 |
$630K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,209 |
4,152 |
$578K |
| D1110 |
Prophylaxis - adult |
5,823 |
5,763 |
$309K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,801 |
2,677 |
$284K |
| D0272 |
Bitewings - two radiographic images |
11,583 |
11,444 |
$260K |
| D1351 |
Sealant - per tooth |
8,826 |
2,704 |
$234K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,377 |
16,248 |
$232K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,240 |
8,065 |
$212K |
| D0274 |
Bitewings - four radiographic images |
6,351 |
6,271 |
$212K |
| D0330 |
Panoramic radiographic image |
2,834 |
2,806 |
$164K |
| D1206 |
Topical application of fluoride varnish |
9,084 |
8,908 |
$129K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,415 |
510 |
$112K |
| D2933 |
|
717 |
206 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
7,185 |
7,015 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,602 |
4,152 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,362 |
1,318 |
$45K |
| D9420 |
|
704 |
699 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
197 |
161 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
79 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
167 |
$3K |
| D0270 |
|
75 |
74 |
$346.92 |
| D0350 |
|
209 |
140 |
$0.00 |
| D0602 |
|
4,073 |
3,997 |
$0.00 |
| D0603 |
|
21,583 |
21,363 |
$0.00 |
| D0601 |
|
3,904 |
3,868 |
$0.00 |