| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,239 |
1,984 |
$579K |
| D0120 |
Periodic oral evaluation - established patient |
10,780 |
10,604 |
$262K |
| D2929 |
|
1,817 |
531 |
$202K |
| D1120 |
Prophylaxis - child |
5,608 |
5,488 |
$187K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,597 |
1,318 |
$155K |
| D1206 |
Topical application of fluoride varnish |
7,136 |
6,974 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,010 |
1,295 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,786 |
1,157 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,978 |
2,842 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,731 |
2,684 |
$79K |
| D1510 |
|
497 |
353 |
$77K |
| D9248 |
|
969 |
892 |
$76K |
| D1110 |
Prophylaxis - adult |
1,561 |
1,521 |
$65K |
| D0330 |
Panoramic radiographic image |
2,116 |
2,065 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,768 |
2,687 |
$44K |
| D1351 |
Sealant - per tooth |
1,219 |
331 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,265 |
1,235 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
246 |
169 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,433 |
1,361 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,238 |
426 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
403 |
391 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
366 |
362 |
$8K |
| D1353 |
|
177 |
49 |
$5K |
| D2330 |
|
16 |
13 |
$1K |
| D1330 |
|
1,912 |
1,865 |
$0.00 |