| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,811 |
1,446 |
$614K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,983 |
3,433 |
$518K |
| D1120 |
Prophylaxis - child |
12,483 |
11,726 |
$439K |
| D0120 |
Periodic oral evaluation - established patient |
10,906 |
10,202 |
$300K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,450 |
7,884 |
$167K |
| D0272 |
Bitewings - two radiographic images |
7,196 |
6,615 |
$151K |
| D1206 |
Topical application of fluoride varnish |
5,648 |
5,331 |
$140K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,212 |
815 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,440 |
2,987 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,669 |
2,447 |
$115K |
| D9920 |
|
1,460 |
1,234 |
$87K |
| D1110 |
Prophylaxis - adult |
1,629 |
1,499 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,535 |
5,853 |
$80K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,213 |
1,121 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
878 |
440 |
$51K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
462 |
167 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,555 |
2,054 |
$34K |
| D1351 |
Sealant - per tooth |
607 |
187 |
$18K |
| D0330 |
Panoramic radiographic image |
298 |
271 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
702 |
619 |
$8K |
| D9248 |
|
42 |
39 |
$5K |
| D9420 |
|
49 |
39 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
89 |
69 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D9986 |
|
328 |
314 |
$0.00 |