| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,114 |
542 |
$292K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,030 |
1,997 |
$277K |
| D1351 |
Sealant - per tooth |
9,787 |
2,038 |
$258K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,192 |
713 |
$204K |
| D1120 |
Prophylaxis - child |
5,005 |
4,928 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
3,958 |
3,918 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,863 |
4,775 |
$98K |
| D1206 |
Topical application of fluoride varnish |
5,490 |
5,407 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,120 |
2,058 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,254 |
5,940 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
6,568 |
6,404 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
836 |
282 |
$63K |
| D9248 |
|
454 |
441 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
455 |
219 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
360 |
360 |
$24K |
| D1110 |
Prophylaxis - adult |
365 |
363 |
$19K |
| D0330 |
Panoramic radiographic image |
828 |
815 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
430 |
413 |
$11K |
| D0274 |
Bitewings - four radiographic images |
346 |
343 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
357 |
349 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
41 |
$4K |
| D0603 |
|
8,756 |
8,613 |
$0.00 |