| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,926 |
990 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
12,208 |
12,121 |
$327K |
| D1110 |
Prophylaxis - adult |
6,841 |
6,748 |
$302K |
| D1120 |
Prophylaxis - child |
8,217 |
8,162 |
$268K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,925 |
1,670 |
$253K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,661 |
11,587 |
$213K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
383 |
367 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,860 |
1,251 |
$168K |
| D0272 |
Bitewings - two radiographic images |
8,016 |
7,948 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,680 |
3,492 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,231 |
1,585 |
$150K |
| D0330 |
Panoramic radiographic image |
2,539 |
2,533 |
$134K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,943 |
2,749 |
$98K |
| D1351 |
Sealant - per tooth |
2,908 |
1,119 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,103 |
4,776 |
$55K |
| D2950 |
|
385 |
337 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
3,221 |
3,088 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
264 |
205 |
$22K |
| D9420 |
|
265 |
249 |
$20K |
| D2390 |
|
79 |
26 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
385 |
336 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,844 |
1,476 |
$13K |
| D2140 |
|
192 |
142 |
$12K |
| D2931 |
|
87 |
25 |
$11K |
| D1206 |
Topical application of fluoride varnish |
389 |
383 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
177 |
176 |
$8K |
| D2330 |
|
102 |
72 |
$8K |
| D3310 |
|
17 |
12 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
43 |
28 |
$4K |
| D9920 |
|
157 |
139 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D7111 |
|
20 |
12 |
$1K |