| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,971 |
1,118 |
$554K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,690 |
2,815 |
$501K |
| D0120 |
Periodic oral evaluation - established patient |
17,243 |
16,989 |
$454K |
| D1120 |
Prophylaxis - child |
15,054 |
14,838 |
$415K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,168 |
18,898 |
$324K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,633 |
5,013 |
$253K |
| D1351 |
Sealant - per tooth |
8,047 |
2,438 |
$231K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,880 |
1,775 |
$231K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,487 |
1,671 |
$222K |
| D1110 |
Prophylaxis - adult |
4,337 |
4,273 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,103 |
3,026 |
$137K |
| D0272 |
Bitewings - two radiographic images |
6,528 |
6,437 |
$120K |
| D0240 |
|
4,181 |
2,146 |
$69K |
| D0330 |
Panoramic radiographic image |
1,065 |
1,050 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,880 |
1,845 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,646 |
3,538 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,465 |
1,420 |
$55K |
| D1510 |
|
253 |
144 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,354 |
2,223 |
$41K |
| D9420 |
|
321 |
309 |
$38K |
| D2330 |
|
184 |
92 |
$12K |
| D2933 |
|
37 |
12 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
15 |
$1K |
| D3120 |
|
22 |
12 |
$0.00 |