| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,387 |
2,054 |
$721K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,986 |
1,895 |
$254K |
| D1120 |
Prophylaxis - child |
10,836 |
10,659 |
$242K |
| D1354 |
|
11,123 |
3,252 |
$183K |
| D1206 |
Topical application of fluoride varnish |
9,794 |
9,637 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
8,890 |
8,706 |
$167K |
| D1351 |
Sealant - per tooth |
6,807 |
2,431 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,588 |
1,598 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,549 |
4,222 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,484 |
1,466 |
$135K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,763 |
782 |
$125K |
| D0330 |
Panoramic radiographic image |
2,120 |
2,083 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,394 |
3,346 |
$103K |
| D0272 |
Bitewings - two radiographic images |
6,610 |
6,479 |
$73K |
| D0240 |
|
4,242 |
2,289 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,287 |
2,882 |
$36K |
| D1110 |
Prophylaxis - adult |
1,106 |
1,061 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
4,914 |
4,370 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,285 |
1,251 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,466 |
1,411 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
882 |
848 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
136 |
135 |
$7K |
| D0350 |
|
384 |
154 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D1330 |
|
2,857 |
2,797 |
$0.00 |
| D0603 |
|
1,515 |
1,499 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |