| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,289 |
1,513 |
$1.21M |
| D0145 |
Oral evaluation for a patient under three years of age |
2,501 |
2,473 |
$350K |
| D2934 |
|
1,319 |
316 |
$188K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,137 |
826 |
$175K |
| D1120 |
Prophylaxis - child |
4,188 |
4,133 |
$148K |
| D0272 |
Bitewings - two radiographic images |
6,483 |
6,294 |
$139K |
| D1351 |
Sealant - per tooth |
5,095 |
1,168 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,342 |
4,294 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,209 |
594 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,505 |
7,370 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,089 |
7,816 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,428 |
707 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,467 |
2,403 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,898 |
4,836 |
$70K |
| D9420 |
|
1,354 |
1,336 |
$48K |
| D0350 |
|
4,435 |
4,262 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
625 |
622 |
$39K |
| D9248 |
|
316 |
305 |
$37K |
| D1110 |
Prophylaxis - adult |
600 |
593 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
337 |
186 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
991 |
932 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,270 |
1,240 |
$23K |
| D0160 |
|
1,326 |
1,310 |
$18K |
| D0274 |
Bitewings - four radiographic images |
339 |
338 |
$11K |
| D7111 |
|
20 |
14 |
$229.40 |
| D1999 |
|
899 |
813 |
$0.00 |
| D0601 |
|
96 |
95 |
$0.00 |
| D0603 |
|
8,098 |
7,707 |
$0.00 |
| D0602 |
|
4,089 |
4,031 |
$0.00 |