| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,331 |
2,487 |
$927K |
| D1120 |
Prophylaxis - child |
20,958 |
20,958 |
$732K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,363 |
3,783 |
$556K |
| D0120 |
Periodic oral evaluation - established patient |
21,142 |
21,142 |
$501K |
| D1206 |
Topical application of fluoride varnish |
24,804 |
24,804 |
$408K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,734 |
9,557 |
$312K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,176 |
1,719 |
$290K |
| D0272 |
Bitewings - two radiographic images |
14,673 |
14,673 |
$279K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,264 |
2,384 |
$276K |
| D1110 |
Prophylaxis - adult |
4,166 |
4,166 |
$208K |
| D1351 |
Sealant - per tooth |
5,937 |
2,303 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,179 |
4,179 |
$169K |
| D0330 |
Panoramic radiographic image |
2,275 |
2,275 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,597 |
2,591 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
6,322 |
6,299 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,890 |
2,890 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,386 |
3,224 |
$78K |
| D0240 |
|
3,355 |
2,980 |
$64K |
| D9420 |
|
699 |
698 |
$60K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
569 |
338 |
$46K |
| D9248 |
|
632 |
629 |
$41K |
| D0145 |
Oral evaluation for a patient under three years of age |
795 |
795 |
$34K |
| D9920 |
|
510 |
510 |
$26K |
| D1354 |
|
1,389 |
531 |
$14K |
| D9310 |
|
207 |
207 |
$13K |
| D2332 |
|
78 |
49 |
$8K |
| D2330 |
|
86 |
53 |
$6K |
| D2934 |
|
28 |
12 |
$4K |
| D7111 |
|
16 |
13 |
$1K |
| D9992 |
|
14 |
14 |
$360.64 |