| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,009 |
1,425 |
$1.37M |
| D2934 |
|
4,503 |
865 |
$622K |
| D0120 |
Periodic oral evaluation - established patient |
20,278 |
20,123 |
$566K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,237 |
1,108 |
$488K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,557 |
3,526 |
$487K |
| D1120 |
Prophylaxis - child |
13,744 |
13,608 |
$480K |
| D1110 |
Prophylaxis - adult |
7,723 |
7,663 |
$404K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,890 |
2,240 |
$364K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,527 |
21,339 |
$305K |
| D0272 |
Bitewings - two radiographic images |
11,644 |
11,517 |
$261K |
| D0274 |
Bitewings - four radiographic images |
7,292 |
7,234 |
$243K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,039 |
1,810 |
$223K |
| D0210 |
Intraoral - complete series of radiographic images |
3,149 |
3,117 |
$201K |
| D1351 |
Sealant - per tooth |
4,669 |
1,446 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
7,183 |
7,023 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,400 |
2,334 |
$79K |
| D9420 |
|
1,530 |
1,492 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,294 |
3,673 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
723 |
275 |
$38K |
| D0350 |
|
3,217 |
3,126 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
654 |
640 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
313 |
301 |
$8K |
| D0330 |
Panoramic radiographic image |
110 |
106 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
14 |
$2K |
| D0603 |
|
27,618 |
27,398 |
$0.00 |
| D1999 |
|
481 |
479 |
$0.00 |