| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,439 |
511 |
$184K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,133 |
1,084 |
$148K |
| D1120 |
Prophylaxis - child |
2,427 |
2,346 |
$83K |
| D9248 |
|
773 |
736 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
1,941 |
1,875 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,980 |
2,446 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,708 |
2,618 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,761 |
1,697 |
$36K |
| D1351 |
Sealant - per tooth |
1,318 |
325 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,847 |
2,686 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
873 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
193 |
71 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
40 |
$4K |
| D0330 |
Panoramic radiographic image |
109 |
106 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
54 |
53 |
$1K |
| D1110 |
Prophylaxis - adult |
25 |
24 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$505.18 |
| D1330 |
|
3,757 |
3,642 |
$12.25 |
| D1310 |
|
3,155 |
3,044 |
$0.00 |
| D0603 |
|
4,319 |
4,173 |
$0.00 |
| D0601 |
|
33 |
33 |
$0.00 |