| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,746 |
2,248 |
$999K |
| D1120 |
Prophylaxis - child |
31,830 |
29,861 |
$837K |
| D0120 |
Periodic oral evaluation - established patient |
25,751 |
24,475 |
$648K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,153 |
4,237 |
$619K |
| D1206 |
Topical application of fluoride varnish |
34,692 |
32,531 |
$532K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,191 |
9,356 |
$432K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,673 |
7,845 |
$354K |
| D1351 |
Sealant - per tooth |
11,084 |
2,980 |
$297K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,780 |
2,324 |
$285K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,427 |
2,590 |
$267K |
| D0272 |
Bitewings - two radiographic images |
12,505 |
11,750 |
$221K |
| D0330 |
Panoramic radiographic image |
3,456 |
3,216 |
$190K |
| D0140 |
Limited oral evaluation - problem focused |
4,608 |
4,196 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
9,648 |
8,831 |
$136K |
| D1110 |
Prophylaxis - adult |
3,387 |
3,226 |
$127K |
| D0240 |
|
5,954 |
2,853 |
$88K |
| D9420 |
|
606 |
512 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,934 |
2,017 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,232 |
1,188 |
$39K |
| D2390 |
|
166 |
57 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
845 |
785 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
164 |
86 |
$13K |
| D1354 |
|
1,810 |
607 |
$11K |
| D7111 |
|
41 |
29 |
$2K |
| D0170 |
|
13 |
12 |
$360.60 |
| D9986 |
|
1,252 |
1,201 |
$0.00 |
| D9987 |
|
892 |
846 |
$0.00 |
| D1999 |
|
7,229 |
6,829 |
$0.00 |
| D1330 |
|
2,003 |
1,541 |
$0.00 |
| D1310 |
|
2,014 |
1,546 |
$0.00 |
| D0171 |
|
62 |
62 |
$0.00 |