| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,781 |
287 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,107 |
426 |
$109K |
| D0145 |
Oral evaluation for a patient under three years of age |
650 |
647 |
$90K |
| D1120 |
Prophylaxis - child |
1,658 |
1,636 |
$58K |
| D9248 |
|
426 |
411 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,836 |
2,102 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,365 |
1,348 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
447 |
116 |
$36K |
| D1351 |
Sealant - per tooth |
1,292 |
319 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,373 |
2,343 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,349 |
2,302 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,003 |
968 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
335 |
331 |
$21K |
| D0272 |
Bitewings - two radiographic images |
830 |
820 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
95 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
389 |
385 |
$13K |
| D0160 |
|
695 |
680 |
$10K |
| D1330 |
|
696 |
679 |
$7K |
| D1110 |
Prophylaxis - adult |
105 |
105 |
$5K |
| D0274 |
Bitewings - four radiographic images |
112 |
112 |
$3K |
| D0603 |
|
4,671 |
4,612 |
$0.00 |