| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,273 |
1,526 |
$615K |
| D1351 |
Sealant - per tooth |
20,127 |
4,383 |
$555K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,097 |
3,066 |
$432K |
| D1120 |
Prophylaxis - child |
11,051 |
10,974 |
$394K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,835 |
2,193 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
12,749 |
12,656 |
$358K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,147 |
13,383 |
$346K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,363 |
1,836 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,501 |
14,392 |
$207K |
| D9248 |
|
1,729 |
1,697 |
$205K |
| D1110 |
Prophylaxis - adult |
3,449 |
3,420 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
14,670 |
14,448 |
$176K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,155 |
875 |
$175K |
| D0272 |
Bitewings - two radiographic images |
6,399 |
6,357 |
$137K |
| D0274 |
Bitewings - four radiographic images |
3,317 |
3,290 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,572 |
3,419 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,665 |
1,648 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
963 |
569 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,943 |
1,897 |
$35K |
| D0330 |
Panoramic radiographic image |
1,081 |
1,071 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
333 |
$22K |
| D2332 |
|
58 |
40 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
29 |
$3K |
| D7111 |
|
78 |
50 |
$893.77 |
| D0603 |
|
17,796 |
17,645 |
$0.61 |