| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,211 |
1,389 |
$454K |
| D1120 |
Prophylaxis - child |
11,346 |
10,844 |
$363K |
| D1206 |
Topical application of fluoride varnish |
12,867 |
12,310 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
10,450 |
9,998 |
$223K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,631 |
1,380 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,860 |
1,784 |
$170K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,829 |
1,858 |
$134K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,680 |
4,417 |
$129K |
| D0272 |
Bitewings - two radiographic images |
5,280 |
5,065 |
$117K |
| D1351 |
Sealant - per tooth |
3,332 |
1,207 |
$81K |
| D1110 |
Prophylaxis - adult |
1,536 |
1,475 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,507 |
1,468 |
$52K |
| D0240 |
|
2,783 |
1,321 |
$40K |
| D0330 |
Panoramic radiographic image |
685 |
652 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,382 |
1,311 |
$37K |
| D2390 |
|
155 |
78 |
$20K |
| D0274 |
Bitewings - four radiographic images |
518 |
499 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,052 |
979 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
328 |
303 |
$10K |
| D1352 |
|
265 |
152 |
$9K |
| D1354 |
|
611 |
263 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
587 |
202 |
$5K |
| D2330 |
|
35 |
25 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
24 |
$584.32 |
| D1330 |
|
8,721 |
8,378 |
$0.00 |