| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,668 |
1,034 |
$747K |
| D1120 |
Prophylaxis - child |
12,234 |
11,533 |
$320K |
| D0120 |
Periodic oral evaluation - established patient |
11,424 |
10,914 |
$294K |
| D1206 |
Topical application of fluoride varnish |
15,380 |
14,424 |
$227K |
| D7962 |
|
1,150 |
986 |
$124K |
| D7960 |
|
1,316 |
559 |
$116K |
| D7961 |
|
883 |
753 |
$107K |
| D0272 |
Bitewings - two radiographic images |
5,535 |
5,243 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
2,216 |
2,083 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,764 |
1,623 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
641 |
382 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,473 |
1,342 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,034 |
382 |
$65K |
| D9420 |
|
615 |
524 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,462 |
1,543 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,664 |
3,374 |
$53K |
| D1110 |
Prophylaxis - adult |
1,121 |
1,082 |
$41K |
| D1351 |
Sealant - per tooth |
1,644 |
687 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
308 |
216 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
234 |
88 |
$18K |
| D2934 |
|
39 |
12 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
375 |
349 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$1K |
| D1354 |
|
154 |
50 |
$885.50 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$495.60 |
| D3120 |
|
51 |
19 |
$0.00 |