| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,436 |
1,850 |
$859K |
| D1120 |
Prophylaxis - child |
15,410 |
15,041 |
$445K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,656 |
2,648 |
$422K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,959 |
1,719 |
$407K |
| D1206 |
Topical application of fluoride varnish |
17,604 |
17,163 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
12,233 |
12,021 |
$272K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,842 |
1,204 |
$250K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,794 |
1,534 |
$199K |
| D1351 |
Sealant - per tooth |
7,232 |
1,719 |
$184K |
| D9420 |
|
2,389 |
2,299 |
$180K |
| D0272 |
Bitewings - two radiographic images |
8,426 |
8,254 |
$176K |
| D0240 |
|
6,275 |
3,398 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,283 |
3,148 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,930 |
2,883 |
$89K |
| D0330 |
Panoramic radiographic image |
1,679 |
1,649 |
$63K |
| D1110 |
Prophylaxis - adult |
1,395 |
1,357 |
$61K |
| D2390 |
|
309 |
95 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,035 |
1,491 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,327 |
1,289 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,516 |
2,474 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
233 |
127 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
305 |
298 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
494 |
472 |
$15K |
| D1510 |
|
82 |
53 |
$12K |
| D2331 |
|
22 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
18 |
$553.32 |