| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,536 |
2,316 |
$1.15M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,407 |
2,011 |
$464K |
| D9248 |
|
2,933 |
2,827 |
$317K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,318 |
7,771 |
$301K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,785 |
1,726 |
$227K |
| D1351 |
Sealant - per tooth |
8,800 |
2,183 |
$217K |
| D2335 |
|
1,311 |
579 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,231 |
1,100 |
$152K |
| D1120 |
Prophylaxis - child |
3,948 |
3,811 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,526 |
4,299 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
8,742 |
8,201 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,695 |
953 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,437 |
3,288 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,663 |
4,503 |
$63K |
| D0272 |
Bitewings - two radiographic images |
2,315 |
2,254 |
$48K |
| D2934 |
|
302 |
102 |
$36K |
| D1330 |
|
4,858 |
4,578 |
$34K |
| D1110 |
Prophylaxis - adult |
561 |
542 |
$28K |
| D2330 |
|
400 |
267 |
$27K |
| D2332 |
|
274 |
152 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,281 |
1,232 |
$25K |
| D0274 |
Bitewings - four radiographic images |
473 |
454 |
$13K |
| D1510 |
|
70 |
52 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
95 |
49 |
$8K |
| D1354 |
|
708 |
96 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
421 |
401 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
80 |
$4K |
| D0170 |
|
630 |
539 |
$3K |
| D9310 |
|
101 |
95 |
$860.22 |
| D0603 |
|
11,405 |
10,831 |
$0.00 |