| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,259 |
1,056 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,868 |
1,866 |
$196K |
| D1120 |
Prophylaxis - child |
6,716 |
6,698 |
$155K |
| D1351 |
Sealant - per tooth |
8,833 |
2,219 |
$154K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,934 |
1,932 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,589 |
1,743 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
6,405 |
6,386 |
$129K |
| D1110 |
Prophylaxis - adult |
2,480 |
2,471 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,543 |
8,516 |
$81K |
| D0272 |
Bitewings - two radiographic images |
5,633 |
5,619 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,884 |
2,877 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,845 |
2,833 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,904 |
2,623 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
750 |
750 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,898 |
4,856 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,934 |
3,670 |
$25K |
| D0330 |
Panoramic radiographic image |
2,334 |
2,329 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
355 |
222 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
500 |
354 |
$19K |
| D7240 |
Removal of impacted tooth - completely bony |
49 |
16 |
$11K |
| D1206 |
Topical application of fluoride varnish |
711 |
710 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
425 |
415 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
68 |
$5K |
| D0270 |
|
18 |
18 |
$57.65 |
| D0603 |
|
8,832 |
8,799 |
$0.04 |
| D1999 |
|
134 |
115 |
$0.00 |
| D0602 |
|
2,333 |
2,322 |
$0.00 |