| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,459 |
606 |
$322K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,585 |
1,580 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,299 |
909 |
$198K |
| D1120 |
Prophylaxis - child |
5,661 |
5,594 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
6,207 |
6,149 |
$169K |
| D1351 |
Sealant - per tooth |
5,406 |
906 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,128 |
7,053 |
$98K |
| D1110 |
Prophylaxis - adult |
1,686 |
1,676 |
$86K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,089 |
331 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,198 |
1,185 |
$79K |
| D0240 |
|
7,303 |
4,150 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,386 |
2,330 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
903 |
388 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,544 |
1,503 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,245 |
1,238 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,447 |
1,373 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,081 |
1,193 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
432 |
236 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,090 |
2,033 |
$24K |
| D9420 |
|
517 |
488 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
819 |
800 |
$14K |
| D0330 |
Panoramic radiographic image |
168 |
164 |
$10K |
| D2933 |
|
43 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
39 |
$6K |
| D1206 |
Topical application of fluoride varnish |
58 |
56 |
$772.93 |
| D0603 |
|
9,337 |
9,288 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |