| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,064 |
1,872 |
$556K |
| D1120 |
Prophylaxis - child |
17,194 |
16,860 |
$538K |
| D0120 |
Periodic oral evaluation - established patient |
20,439 |
20,064 |
$474K |
| D1206 |
Topical application of fluoride varnish |
20,120 |
19,750 |
$400K |
| D9248 |
|
4,191 |
3,551 |
$312K |
| D1110 |
Prophylaxis - adult |
4,798 |
4,697 |
$198K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,262 |
1,765 |
$176K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,953 |
808 |
$157K |
| D0272 |
Bitewings - two radiographic images |
8,028 |
7,876 |
$136K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,901 |
1,078 |
$135K |
| D2140 |
|
2,072 |
1,151 |
$123K |
| D1351 |
Sealant - per tooth |
3,673 |
1,056 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
3,618 |
3,525 |
$80K |
| D0274 |
Bitewings - four radiographic images |
3,029 |
2,960 |
$80K |
| D0330 |
Panoramic radiographic image |
1,509 |
1,493 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
3,440 |
3,304 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,258 |
1,203 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,402 |
1,364 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,282 |
2,129 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
616 |
607 |
$17K |
| D2933 |
|
97 |
25 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
50 |
$963.00 |
| D9420 |
|
142 |
136 |
$25.00 |