| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,633 |
2,335 |
$920K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,580 |
4,550 |
$643K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,461 |
2,960 |
$510K |
| D1120 |
Prophylaxis - child |
14,376 |
14,233 |
$493K |
| D1351 |
Sealant - per tooth |
18,427 |
4,162 |
$491K |
| D0120 |
Periodic oral evaluation - established patient |
16,324 |
16,191 |
$446K |
| D0272 |
Bitewings - two radiographic images |
14,187 |
14,046 |
$295K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,286 |
1,260 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,159 |
1,734 |
$231K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,046 |
16,359 |
$218K |
| D1110 |
Prophylaxis - adult |
4,159 |
4,130 |
$212K |
| D0220 |
Intraoral - periapical first radiographic image |
18,555 |
18,248 |
$206K |
| D1206 |
Topical application of fluoride varnish |
14,362 |
14,249 |
$203K |
| D9248 |
|
1,654 |
1,582 |
$182K |
| D2332 |
|
893 |
522 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,966 |
1,144 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,408 |
2,393 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,590 |
2,550 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,044 |
1,037 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,766 |
1,736 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,989 |
3,940 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
2,815 |
2,769 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
565 |
456 |
$51K |
| D2934 |
|
293 |
90 |
$41K |
| D0330 |
Panoramic radiographic image |
2,456 |
2,423 |
$35K |
| D2330 |
|
482 |
271 |
$35K |
| D9420 |
|
454 |
449 |
$19K |
| D2335 |
|
40 |
26 |
$6K |
| D0270 |
|
544 |
535 |
$2K |
| D1354 |
|
194 |
54 |
$2K |
| D7111 |
|
54 |
41 |
$714.44 |
| D0603 |
|
21,593 |
21,445 |
$0.00 |