| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,145 |
2,278 |
$634K |
| D1120 |
Prophylaxis - child |
19,651 |
19,525 |
$624K |
| D9920 |
|
4,759 |
4,650 |
$599K |
| D1206 |
Topical application of fluoride varnish |
27,973 |
27,466 |
$533K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,459 |
3,964 |
$484K |
| D1351 |
Sealant - per tooth |
17,426 |
5,236 |
$480K |
| D0120 |
Periodic oral evaluation - established patient |
19,866 |
19,738 |
$419K |
| D9248 |
|
1,636 |
1,578 |
$311K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,241 |
6,035 |
$297K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,610 |
1,892 |
$255K |
| D0272 |
Bitewings - two radiographic images |
10,352 |
10,283 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,999 |
2,089 |
$161K |
| D1110 |
Prophylaxis - adult |
3,624 |
3,602 |
$134K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,339 |
939 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,347 |
3,326 |
$72K |
| D2390 |
|
338 |
123 |
$57K |
| D9110 |
|
1,568 |
1,541 |
$51K |
| D0240 |
|
1,634 |
1,592 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
4,446 |
4,378 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
476 |
299 |
$38K |
| D0330 |
Panoramic radiographic image |
867 |
863 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,819 |
1,736 |
$32K |
| D0603 |
|
3,310 |
3,280 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,003 |
998 |
$29K |
| D1510 |
|
162 |
116 |
$21K |
| D2330 |
|
316 |
199 |
$17K |
| D2332 |
|
230 |
138 |
$17K |
| D1330 |
|
3,472 |
3,442 |
$15K |
| D1517 |
|
27 |
27 |
$6K |
| D1354 |
|
72 |
40 |
$2K |
| D0270 |
|
38 |
38 |
$343.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$239.06 |
| D1310 |
|
388 |
388 |
$0.00 |
| D1999 |
|
69 |
69 |
$0.00 |