| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,214 |
632 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,577 |
1,016 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,461 |
822 |
$118K |
| D1120 |
Prophylaxis - child |
2,845 |
2,835 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
2,821 |
2,817 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
494 |
352 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,473 |
2,463 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,152 |
3,048 |
$49K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
438 |
271 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,036 |
2,330 |
$43K |
| D1354 |
|
1,460 |
436 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
798 |
780 |
$31K |
| D1510 |
|
165 |
138 |
$28K |
| D1352 |
|
367 |
147 |
$25K |
| D1110 |
Prophylaxis - adult |
495 |
494 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
268 |
177 |
$24K |
| D0272 |
Bitewings - two radiographic images |
937 |
937 |
$21K |
| D1206 |
Topical application of fluoride varnish |
576 |
576 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$3K |
| D0274 |
Bitewings - four radiographic images |
64 |
64 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
38 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
16 |
$0.00 |
| D0603 |
|
146 |
140 |
$0.00 |