| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,797 |
1,557 |
$645K |
| D0120 |
Periodic oral evaluation - established patient |
15,140 |
14,520 |
$384K |
| D1120 |
Prophylaxis - child |
11,525 |
10,951 |
$383K |
| D1206 |
Topical application of fluoride varnish |
16,458 |
15,681 |
$314K |
| D0272 |
Bitewings - two radiographic images |
12,920 |
12,356 |
$294K |
| D0220 |
Intraoral - periapical first radiographic image |
15,302 |
14,447 |
$255K |
| D1110 |
Prophylaxis - adult |
4,965 |
4,786 |
$227K |
| D9248 |
|
2,282 |
2,095 |
$203K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,650 |
13,702 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,593 |
1,324 |
$163K |
| D1351 |
Sealant - per tooth |
4,418 |
1,468 |
$118K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,061 |
3,776 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
982 |
901 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
758 |
382 |
$58K |
| D0603 |
|
11,826 |
11,422 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,151 |
1,038 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
203 |
$34K |
| D0330 |
Panoramic radiographic image |
947 |
899 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
767 |
735 |
$23K |
| D2140 |
|
367 |
199 |
$23K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
226 |
154 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
106 |
$11K |
| D1354 |
|
270 |
57 |
$2K |
| D7111 |
|
32 |
27 |
$1K |
| D1999 |
|
380 |
369 |
$0.00 |