| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,912 |
3,482 |
$2.10M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,539 |
3,635 |
$857K |
| D1120 |
Prophylaxis - child |
19,790 |
19,113 |
$666K |
| D0120 |
Periodic oral evaluation - established patient |
23,774 |
23,071 |
$634K |
| D1351 |
Sealant - per tooth |
25,534 |
4,957 |
$630K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,749 |
3,644 |
$490K |
| D0230 |
Intraoral - periapical each additional radiographic image |
54,406 |
19,248 |
$474K |
| D1110 |
Prophylaxis - adult |
5,482 |
5,346 |
$277K |
| D0220 |
Intraoral - periapical first radiographic image |
22,564 |
21,667 |
$226K |
| D1206 |
Topical application of fluoride varnish |
16,910 |
16,490 |
$223K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,050 |
1,547 |
$206K |
| D0272 |
Bitewings - two radiographic images |
10,598 |
10,277 |
$198K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,949 |
6,699 |
$164K |
| D0274 |
Bitewings - four radiographic images |
5,658 |
5,519 |
$161K |
| D0210 |
Intraoral - complete series of radiographic images |
3,621 |
3,561 |
$143K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,764 |
1,342 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,574 |
10,075 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,123 |
3,943 |
$119K |
| D9248 |
|
1,077 |
1,021 |
$96K |
| D0330 |
Panoramic radiographic image |
5,339 |
5,054 |
$86K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
771 |
287 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,396 |
1,353 |
$23K |
| D9420 |
|
364 |
354 |
$12K |
| D2934 |
|
37 |
12 |
$5K |
| D1510 |
|
15 |
12 |
$2K |
| D0170 |
|
67 |
63 |
$676.49 |
| D9430 |
|
53 |
52 |
$558.87 |
| D1354 |
|
35 |
14 |
$254.16 |
| D0603 |
|
27,405 |
26,524 |
$0.18 |
| D0602 |
|
4,637 |
4,508 |
$0.02 |
| D0601 |
|
2,319 |
2,245 |
$0.01 |