| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,854 |
485 |
$238K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,694 |
1,673 |
$229K |
| D1351 |
Sealant - per tooth |
6,853 |
1,346 |
$173K |
| D1120 |
Prophylaxis - child |
4,652 |
4,510 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,727 |
780 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,091 |
5,652 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
4,357 |
4,211 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
6,380 |
6,061 |
$66K |
| D9248 |
|
480 |
457 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,803 |
1,711 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,969 |
2,908 |
$41K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
485 |
192 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,592 |
2,464 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,044 |
998 |
$34K |
| D1110 |
Prophylaxis - adult |
676 |
639 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
229 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,518 |
1,485 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
876 |
794 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
233 |
233 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
282 |
133 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
863 |
791 |
$14K |
| D0330 |
Panoramic radiographic image |
695 |
674 |
$9K |
| D2934 |
|
19 |
12 |
$3K |
| D1330 |
|
71 |
69 |
$693.37 |
| D7111 |
|
25 |
13 |
$286.75 |
| D0603 |
|
4,752 |
4,632 |
$0.11 |
| D0602 |
|
2,488 |
2,424 |
$0.00 |
| D0601 |
|
346 |
341 |
$0.00 |