| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,352 |
1,737 |
$1.03M |
| D0145 |
Oral evaluation for a patient under three years of age |
2,049 |
2,035 |
$286K |
| D1120 |
Prophylaxis - child |
5,190 |
5,139 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
5,307 |
5,258 |
$149K |
| D1351 |
Sealant - per tooth |
5,451 |
1,495 |
$147K |
| D9248 |
|
1,137 |
1,108 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,565 |
945 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,946 |
5,889 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,720 |
3,682 |
$83K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
975 |
340 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,658 |
1,641 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,654 |
3,517 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,439 |
2,183 |
$43K |
| D1110 |
Prophylaxis - adult |
685 |
680 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
926 |
908 |
$25K |
| D1330 |
|
1,528 |
1,516 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
131 |
$17K |
| D9420 |
|
386 |
378 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
566 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
79 |
$9K |
| D0350 |
|
413 |
402 |
$6K |
| D0274 |
Bitewings - four radiographic images |
42 |
41 |
$1K |
| D0603 |
|
9,244 |
9,170 |
$0.00 |