| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,355 |
1,445 |
$460K |
| D1120 |
Prophylaxis - child |
7,430 |
7,319 |
$256K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,700 |
1,676 |
$234K |
| D1351 |
Sealant - per tooth |
8,763 |
2,430 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,226 |
1,646 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
7,093 |
6,985 |
$193K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,508 |
1,702 |
$169K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,055 |
869 |
$158K |
| D9248 |
|
1,421 |
1,376 |
$146K |
| D0272 |
Bitewings - two radiographic images |
6,155 |
6,042 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,599 |
8,477 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
8,532 |
8,263 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,597 |
4,376 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,186 |
6,774 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,274 |
2,238 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,206 |
789 |
$61K |
| D1110 |
Prophylaxis - adult |
1,022 |
1,012 |
$53K |
| D0330 |
Panoramic radiographic image |
832 |
816 |
$32K |
| D0274 |
Bitewings - four radiographic images |
947 |
928 |
$30K |
| D9420 |
|
412 |
390 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
629 |
616 |
$11K |
| D1510 |
|
56 |
49 |
$8K |
| D2330 |
|
59 |
38 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$3K |
| D0270 |
|
421 |
416 |
$2K |
| D7111 |
|
18 |
15 |
$194.10 |
| D3120 |
|
13 |
12 |
$28.67 |
| D0603 |
|
11,500 |
11,336 |
$0.00 |
| D0191 |
|
90 |
85 |
$0.00 |