| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,419 |
1,109 |
$705K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,577 |
3,448 |
$475K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,524 |
1,592 |
$408K |
| D1120 |
Prophylaxis - child |
10,303 |
9,963 |
$346K |
| D1351 |
Sealant - per tooth |
11,948 |
2,278 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
10,877 |
10,546 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,449 |
11,897 |
$277K |
| D0220 |
Intraoral - periapical first radiographic image |
13,562 |
12,843 |
$137K |
| D1206 |
Topical application of fluoride varnish |
9,210 |
8,899 |
$124K |
| D0272 |
Bitewings - two radiographic images |
5,980 |
5,766 |
$116K |
| D1110 |
Prophylaxis - adult |
2,253 |
2,185 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,593 |
2,415 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,079 |
505 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,994 |
2,879 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,907 |
1,845 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,534 |
3,435 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
815 |
371 |
$43K |
| D0330 |
Panoramic radiographic image |
1,304 |
1,232 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
304 |
304 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,020 |
989 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
106 |
39 |
$8K |
| D9248 |
|
25 |
25 |
$3K |
| D9420 |
|
13 |
12 |
$396.62 |
| D0603 |
|
17,403 |
16,881 |
$0.00 |