| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,957 |
1,475 |
$665K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,599 |
3,270 |
$512K |
| D1120 |
Prophylaxis - child |
11,535 |
11,102 |
$407K |
| D0120 |
Periodic oral evaluation - established patient |
11,551 |
11,091 |
$320K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,954 |
8,603 |
$181K |
| D0272 |
Bitewings - two radiographic images |
6,908 |
6,556 |
$148K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,507 |
3,139 |
$130K |
| D1110 |
Prophylaxis - adult |
2,255 |
2,138 |
$109K |
| D1206 |
Topical application of fluoride varnish |
4,350 |
4,210 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
935 |
677 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,166 |
2,049 |
$99K |
| D9920 |
|
1,597 |
1,386 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
6,690 |
6,066 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,207 |
631 |
$79K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
873 |
341 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,518 |
2,398 |
$42K |
| D0145 |
Oral evaluation for a patient under three years of age |
499 |
499 |
$24K |
| D0330 |
Panoramic radiographic image |
276 |
274 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
196 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
859 |
776 |
$10K |
| D9420 |
|
91 |
75 |
$8K |
| D1351 |
Sealant - per tooth |
222 |
84 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
42 |
$4K |
| D9248 |
|
16 |
14 |
$2K |
| D9986 |
|
269 |
259 |
$0.00 |