| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,539 |
1,510 |
$842K |
| D1120 |
Prophylaxis - child |
11,189 |
10,817 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
8,087 |
7,835 |
$217K |
| D1206 |
Topical application of fluoride varnish |
10,983 |
10,628 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,851 |
970 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,531 |
3,155 |
$135K |
| D0272 |
Bitewings - two radiographic images |
4,599 |
4,428 |
$84K |
| D0603 |
|
7,597 |
7,337 |
$79K |
| D1351 |
Sealant - per tooth |
3,541 |
1,050 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,997 |
1,923 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
678 |
278 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,123 |
3,823 |
$53K |
| D0240 |
|
2,899 |
1,628 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
702 |
433 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,722 |
1,580 |
$42K |
| D9310 |
|
390 |
386 |
$40K |
| D0330 |
Panoramic radiographic image |
893 |
876 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,007 |
966 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
267 |
123 |
$25K |
| D0602 |
|
2,182 |
2,097 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
451 |
417 |
$17K |
| D2330 |
|
165 |
56 |
$12K |
| D1354 |
|
465 |
190 |
$9K |
| D2390 |
|
44 |
12 |
$8K |
| D1110 |
Prophylaxis - adult |
129 |
111 |
$4K |
| D0274 |
Bitewings - four radiographic images |
132 |
129 |
$3K |
| D1510 |
|
15 |
12 |
$2K |
| D0601 |
|
150 |
145 |
$2K |
| D9920 |
|
61 |
57 |
$2K |
| D1330 |
|
9,686 |
9,318 |
$0.03 |
| D1999 |
|
433 |
387 |
$0.00 |
| D1310 |
|
9,744 |
9,386 |
$0.00 |
| D1320 |
|
111 |
109 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
12 |
$0.00 |