| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,117 |
3,015 |
$1.69M |
| D0145 |
Oral evaluation for a patient under three years of age |
8,070 |
7,973 |
$1.12M |
| D1120 |
Prophylaxis - child |
27,258 |
26,816 |
$967K |
| D0120 |
Periodic oral evaluation - established patient |
27,522 |
27,062 |
$767K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,008 |
3,018 |
$553K |
| D1351 |
Sealant - per tooth |
18,546 |
3,864 |
$494K |
| D0272 |
Bitewings - two radiographic images |
21,135 |
20,773 |
$471K |
| D1206 |
Topical application of fluoride varnish |
29,779 |
29,287 |
$425K |
| D0220 |
Intraoral - periapical first radiographic image |
28,493 |
27,932 |
$324K |
| D0210 |
Intraoral - complete series of radiographic images |
4,654 |
4,617 |
$320K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,576 |
1,144 |
$285K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,448 |
25,683 |
$274K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,919 |
1,380 |
$160K |
| D9248 |
|
1,293 |
1,273 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,030 |
1,242 |
$148K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,695 |
5,572 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,847 |
3,772 |
$130K |
| D1110 |
Prophylaxis - adult |
1,989 |
1,940 |
$104K |
| D0274 |
Bitewings - four radiographic images |
1,991 |
1,924 |
$62K |
| D0330 |
Panoramic radiographic image |
1,789 |
1,714 |
$52K |
| D9420 |
|
1,313 |
1,296 |
$47K |
| D2934 |
|
327 |
95 |
$46K |
| D2330 |
|
470 |
196 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,759 |
1,744 |
$32K |
| D2332 |
|
124 |
59 |
$16K |
| D7111 |
|
29 |
15 |
$309.69 |
| D0270 |
|
12 |
12 |
$58.80 |
| D0603 |
|
40,025 |
39,463 |
$0.00 |