| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,340 |
1,620 |
$592K |
| D0120 |
Periodic oral evaluation - established patient |
20,225 |
19,469 |
$550K |
| D1120 |
Prophylaxis - child |
15,452 |
14,836 |
$531K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,970 |
2,282 |
$353K |
| D9248 |
|
2,991 |
2,762 |
$323K |
| D1110 |
Prophylaxis - adult |
6,087 |
5,859 |
$312K |
| D1206 |
Topical application of fluoride varnish |
20,663 |
19,882 |
$286K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,913 |
1,855 |
$257K |
| D0272 |
Bitewings - two radiographic images |
8,055 |
7,705 |
$176K |
| D0274 |
Bitewings - four radiographic images |
3,653 |
3,526 |
$119K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,628 |
4,221 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,206 |
893 |
$86K |
| D1351 |
Sealant - per tooth |
3,057 |
811 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,832 |
1,699 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
5,051 |
4,703 |
$56K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
614 |
381 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,111 |
591 |
$44K |
| D0330 |
Panoramic radiographic image |
701 |
680 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,806 |
1,703 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
462 |
435 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,591 |
1,878 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
442 |
421 |
$6K |
| D7111 |
|
387 |
242 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
28 |
$2K |
| D3120 |
|
13 |
12 |
$57.34 |
| D0603 |
|
11,800 |
11,364 |
$0.00 |
| D0601 |
|
2,167 |
2,081 |
$0.00 |
| D0602 |
|
10,108 |
9,784 |
$0.00 |
| D1999 |
|
22 |
20 |
$0.00 |