| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,139 |
1,576 |
$1.04M |
| D0145 |
Oral evaluation for a patient under three years of age |
7,331 |
7,301 |
$1.03M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,185 |
4,274 |
$780K |
| D0120 |
Periodic oral evaluation - established patient |
23,657 |
23,538 |
$672K |
| D1120 |
Prophylaxis - child |
17,915 |
17,833 |
$643K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,876 |
2,662 |
$548K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,050 |
24,308 |
$471K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,019 |
24,875 |
$359K |
| D1110 |
Prophylaxis - adult |
6,731 |
6,692 |
$359K |
| D0220 |
Intraoral - periapical first radiographic image |
25,587 |
25,324 |
$304K |
| D1351 |
Sealant - per tooth |
11,371 |
2,558 |
$302K |
| D0272 |
Bitewings - two radiographic images |
11,242 |
11,182 |
$254K |
| D0274 |
Bitewings - four radiographic images |
6,564 |
6,527 |
$216K |
| D9248 |
|
1,637 |
1,613 |
$189K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,487 |
617 |
$122K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,649 |
2,594 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,668 |
1,648 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
678 |
674 |
$44K |
| D0160 |
|
2,128 |
2,107 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
259 |
175 |
$25K |
| D0330 |
Panoramic radiographic image |
928 |
914 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,279 |
1,255 |
$23K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
363 |
156 |
$18K |
| D1330 |
|
1,520 |
1,510 |
$16K |
| D9222 |
|
165 |
156 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
66 |
$7K |
| D0350 |
|
343 |
333 |
$4K |
| D9612 |
|
60 |
59 |
$2K |
| D7111 |
|
95 |
67 |
$1K |
| D3120 |
|
585 |
391 |
$114.68 |
| D0603 |
|
33,386 |
33,195 |
$0.00 |