| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,346 |
1,316 |
$917K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,470 |
2,443 |
$346K |
| D1120 |
Prophylaxis - child |
9,522 |
9,382 |
$342K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,037 |
7,378 |
$329K |
| D1351 |
Sealant - per tooth |
11,850 |
3,099 |
$323K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,710 |
868 |
$221K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,546 |
11,375 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
5,437 |
5,353 |
$153K |
| D0220 |
Intraoral - periapical first radiographic image |
12,588 |
12,286 |
$153K |
| D9248 |
|
1,162 |
1,136 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,260 |
839 |
$127K |
| D1110 |
Prophylaxis - adult |
2,029 |
1,997 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,972 |
2,941 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,124 |
755 |
$84K |
| D0274 |
Bitewings - four radiographic images |
1,984 |
1,952 |
$67K |
| D0272 |
Bitewings - two radiographic images |
1,889 |
1,864 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
738 |
382 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,470 |
1,433 |
$38K |
| D0330 |
Panoramic radiographic image |
558 |
540 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,429 |
1,399 |
$26K |
| D1330 |
|
2,356 |
2,303 |
$22K |
| D9420 |
|
152 |
150 |
$5K |
| D0350 |
|
380 |
369 |
$4K |
| D1354 |
|
355 |
132 |
$4K |
| D0603 |
|
12,635 |
12,402 |
$0.12 |
| D1999 |
|
1,168 |
1,126 |
$0.00 |
| D0190 |
|
1,177 |
1,134 |
$0.00 |