| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,007 |
1,321 |
$600K |
| D2390 |
|
1,651 |
480 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,299 |
4,206 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,745 |
1,044 |
$120K |
| D1120 |
Prophylaxis - child |
6,140 |
6,015 |
$116K |
| D9420 |
|
1,279 |
1,256 |
$82K |
| D1206 |
Topical application of fluoride varnish |
6,538 |
6,387 |
$79K |
| D1351 |
Sealant - per tooth |
4,214 |
1,047 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,530 |
654 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
3,022 |
2,956 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,935 |
3,852 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
740 |
437 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,993 |
3,102 |
$42K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
676 |
408 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,462 |
3,356 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,225 |
1,173 |
$25K |
| D0330 |
Panoramic radiographic image |
850 |
844 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
1,058 |
1,015 |
$24K |
| D1110 |
Prophylaxis - adult |
633 |
610 |
$18K |
| D0274 |
Bitewings - four radiographic images |
694 |
671 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
715 |
643 |
$14K |
| D2330 |
|
172 |
118 |
$8K |
| D2331 |
|
62 |
37 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
94 |
$3K |
| D0171 |
|
172 |
171 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
213 |
213 |
$2K |
| D3120 |
|
58 |
25 |
$1K |