| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,352 |
1,717 |
$598K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,080 |
2,417 |
$268K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,412 |
7,252 |
$213K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,494 |
2,081 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,737 |
1,204 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,110 |
3,582 |
$147K |
| D1351 |
Sealant - per tooth |
4,745 |
1,389 |
$98K |
| D1120 |
Prophylaxis - child |
1,907 |
1,742 |
$79K |
| D0272 |
Bitewings - two radiographic images |
4,160 |
4,037 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,802 |
2,679 |
$66K |
| D0330 |
Panoramic radiographic image |
1,197 |
1,169 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,699 |
2,573 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,992 |
1,820 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,298 |
925 |
$17K |
| D9420 |
|
281 |
266 |
$17K |
| D1110 |
Prophylaxis - adult |
203 |
190 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
129 |
84 |
$8K |
| D1354 |
|
801 |
225 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
244 |
215 |
$7K |
| D9110 |
|
138 |
136 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
50 |
$5K |
| D0274 |
Bitewings - four radiographic images |
153 |
141 |
$5K |
| D1353 |
|
262 |
89 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
119 |
103 |
$2K |
| D2330 |
|
15 |
13 |
$858.00 |
| D1206 |
Topical application of fluoride varnish |
54 |
51 |
$697.65 |
| D0603 |
|
65 |
58 |
$0.00 |
| D9986 |
|
187 |
152 |
$0.00 |