| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,979 |
2,224 |
$649K |
| D0120 |
Periodic oral evaluation - established patient |
23,177 |
22,435 |
$467K |
| D1120 |
Prophylaxis - child |
15,498 |
14,985 |
$423K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,654 |
4,471 |
$410K |
| D1110 |
Prophylaxis - adult |
9,444 |
9,158 |
$405K |
| D1206 |
Topical application of fluoride varnish |
12,985 |
12,641 |
$295K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,647 |
8,139 |
$266K |
| D0272 |
Bitewings - two radiographic images |
11,576 |
11,209 |
$249K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,989 |
1,767 |
$212K |
| D0330 |
Panoramic radiographic image |
3,601 |
3,461 |
$195K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,487 |
2,764 |
$166K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,088 |
9,676 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,696 |
2,604 |
$89K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
554 |
332 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
561 |
532 |
$16K |
| D2330 |
|
227 |
154 |
$16K |
| D2332 |
|
153 |
103 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
632 |
595 |
$7K |
| D2331 |
|
66 |
38 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
55 |
$4K |
| D1351 |
Sealant - per tooth |
67 |
30 |
$2K |
| D0274 |
Bitewings - four radiographic images |
26 |
25 |
$844.08 |
| D3120 |
|
14 |
12 |
$0.00 |