| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,473 |
3,596 |
$2.26M |
| D0145 |
Oral evaluation for a patient under three years of age |
11,484 |
11,348 |
$1.58M |
| D1120 |
Prophylaxis - child |
38,325 |
37,667 |
$1.26M |
| D0120 |
Periodic oral evaluation - established patient |
42,929 |
42,226 |
$1.17M |
| D1351 |
Sealant - per tooth |
35,642 |
8,522 |
$875K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,463 |
4,312 |
$683K |
| D1208 |
Topical application of fluoride, excluding varnish |
46,840 |
46,109 |
$629K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,076 |
4,181 |
$517K |
| D1110 |
Prophylaxis - adult |
9,892 |
9,740 |
$510K |
| D0272 |
Bitewings - two radiographic images |
24,474 |
24,062 |
$509K |
| D0274 |
Bitewings - four radiographic images |
11,256 |
11,061 |
$348K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,048 |
1,879 |
$217K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,427 |
8,168 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,566 |
11,576 |
$208K |
| D0220 |
Intraoral - periapical first radiographic image |
18,212 |
17,747 |
$199K |
| D9248 |
|
1,311 |
1,276 |
$149K |
| D0330 |
Panoramic radiographic image |
4,952 |
4,869 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,172 |
4,085 |
$137K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,287 |
606 |
$100K |
| D9420 |
|
2,549 |
2,491 |
$87K |
| D2934 |
|
487 |
160 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
887 |
887 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,765 |
1,718 |
$31K |
| D0350 |
|
3,539 |
3,039 |
$26K |
| D0170 |
|
2,771 |
2,699 |
$19K |
| D1206 |
Topical application of fluoride varnish |
702 |
605 |
$7K |
| D0603 |
|
55,330 |
54,692 |
$0.00 |
| D0600 |
|
149 |
147 |
$0.00 |
| D0601 |
|
3,514 |
3,441 |
$0.00 |
| D0602 |
|
396 |
390 |
$0.00 |
| D9986 |
|
316 |
315 |
$0.00 |