| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,223 |
1,650 |
$606K |
| D1120 |
Prophylaxis - child |
11,967 |
11,953 |
$511K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,351 |
1,870 |
$413K |
| D0120 |
Periodic oral evaluation - established patient |
11,685 |
11,671 |
$394K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,111 |
9,096 |
$249K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,608 |
1,597 |
$222K |
| D0272 |
Bitewings - two radiographic images |
5,717 |
5,708 |
$145K |
| D0140 |
Limited oral evaluation - problem focused |
2,008 |
1,992 |
$122K |
| D1351 |
Sealant - per tooth |
3,744 |
1,141 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,227 |
872 |
$114K |
| D1206 |
Topical application of fluoride varnish |
3,394 |
3,394 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,402 |
1,398 |
$76K |
| D1110 |
Prophylaxis - adult |
1,172 |
1,172 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
3,150 |
3,128 |
$58K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
432 |
313 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,549 |
1,672 |
$34K |
| D0274 |
Bitewings - four radiographic images |
835 |
835 |
$33K |
| D0330 |
Panoramic radiographic image |
372 |
372 |
$27K |
| D1510 |
|
70 |
55 |
$14K |
| D0240 |
|
553 |
295 |
$12K |
| D9248 |
|
79 |
77 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
52 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,445 |
1,416 |
$0.00 |