| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,697 |
1,382 |
$521K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,135 |
2,131 |
$299K |
| D1120 |
Prophylaxis - child |
7,660 |
7,632 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
9,674 |
9,634 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,245 |
1,573 |
$220K |
| D9248 |
|
1,872 |
1,860 |
$209K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,068 |
10,028 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,783 |
1,268 |
$134K |
| D0272 |
Bitewings - two radiographic images |
6,308 |
6,268 |
$130K |
| D1110 |
Prophylaxis - adult |
2,384 |
2,373 |
$126K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,193 |
715 |
$95K |
| D0274 |
Bitewings - four radiographic images |
3,051 |
3,036 |
$89K |
| D1351 |
Sealant - per tooth |
2,869 |
1,096 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,020 |
1,020 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,230 |
848 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,894 |
1,862 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,061 |
3,821 |
$45K |
| D0330 |
Panoramic radiographic image |
1,576 |
1,569 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
685 |
667 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,907 |
1,489 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
734 |
727 |
$13K |
| D2330 |
|
22 |
12 |
$1K |
| D9420 |
|
13 |
13 |
$435.72 |
| D0603 |
|
12,046 |
12,005 |
$0.00 |
| D0601 |
|
180 |
178 |
$0.00 |