| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,797 |
2,994 |
$985K |
| D1120 |
Prophylaxis - child |
24,709 |
23,838 |
$793K |
| D0120 |
Periodic oral evaluation - established patient |
24,596 |
23,718 |
$561K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,447 |
3,768 |
$442K |
| D8670 |
Periodic orthodontic treatment visit |
4,882 |
4,593 |
$434K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,175 |
4,086 |
$406K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,834 |
3,054 |
$386K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,697 |
18,936 |
$378K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,587 |
1,520 |
$266K |
| D9248 |
|
3,298 |
2,946 |
$260K |
| D0272 |
Bitewings - two radiographic images |
12,140 |
11,696 |
$202K |
| D1110 |
Prophylaxis - adult |
4,516 |
4,364 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
3,188 |
3,075 |
$181K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,494 |
5,973 |
$179K |
| D1206 |
Topical application of fluoride varnish |
8,454 |
8,204 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
13,209 |
12,677 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,822 |
4,670 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,250 |
10,717 |
$126K |
| D1351 |
Sealant - per tooth |
4,458 |
1,593 |
$118K |
| D2934 |
|
929 |
264 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,165 |
2,096 |
$56K |
| D0330 |
Panoramic radiographic image |
1,427 |
1,370 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
2,169 |
2,052 |
$47K |
| D8660 |
|
962 |
951 |
$45K |
| D3230 |
|
743 |
157 |
$36K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
17 |
17 |
$22K |
| D2332 |
|
168 |
113 |
$12K |
| D1510 |
|
55 |
42 |
$8K |
| D2330 |
|
97 |
59 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$983.95 |
| D9420 |
|
1,009 |
909 |
$530.00 |
| D1999 |
|
5,014 |
4,546 |
$0.00 |