| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,600 |
1,345 |
$634K |
| D1120 |
Prophylaxis - child |
14,229 |
13,681 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
10,460 |
10,076 |
$199K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,727 |
1,113 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,820 |
1,723 |
$169K |
| D1206 |
Topical application of fluoride varnish |
8,226 |
7,882 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,868 |
4,664 |
$135K |
| D1351 |
Sealant - per tooth |
4,869 |
1,564 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,010 |
1,264 |
$115K |
| D0240 |
|
11,364 |
4,533 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,338 |
6,123 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,682 |
2,471 |
$89K |
| D0272 |
Bitewings - two radiographic images |
7,967 |
7,672 |
$86K |
| D1354 |
|
3,028 |
875 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
875 |
345 |
$57K |
| D0330 |
Panoramic radiographic image |
840 |
802 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
241 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
740 |
685 |
$22K |
| D2335 |
|
184 |
60 |
$17K |
| D0274 |
Bitewings - four radiographic images |
839 |
819 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,058 |
1,984 |
$11K |
| D1110 |
Prophylaxis - adult |
272 |
265 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,665 |
854 |
$8K |
| D0350 |
|
684 |
190 |
$6K |
| D2332 |
|
55 |
25 |
$4K |
| D2330 |
|
24 |
12 |
$1K |
| D0270 |
|
108 |
97 |
$521.50 |
| D1330 |
|
46 |
46 |
$0.00 |
| D1999 |
|
120 |
119 |
$0.00 |