| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,858 |
1,323 |
$396K |
| D1120 |
Prophylaxis - child |
8,726 |
8,232 |
$270K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,542 |
1,661 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,061 |
1,326 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
6,524 |
6,160 |
$144K |
| D9248 |
|
1,551 |
1,366 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,144 |
5,838 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,823 |
1,054 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,700 |
3,473 |
$98K |
| D1206 |
Topical application of fluoride varnish |
3,856 |
3,577 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,479 |
1,361 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,367 |
2,156 |
$64K |
| D8670 |
Periodic orthodontic treatment visit |
725 |
637 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,989 |
3,727 |
$51K |
| D1110 |
Prophylaxis - adult |
1,235 |
1,149 |
$49K |
| D1351 |
Sealant - per tooth |
1,644 |
521 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
430 |
219 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,555 |
2,358 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
801 |
740 |
$17K |
| D0274 |
Bitewings - four radiographic images |
665 |
614 |
$12K |
| D0330 |
Panoramic radiographic image |
177 |
159 |
$6K |
| D2929 |
|
37 |
13 |
$4K |
| D8660 |
|
97 |
96 |
$4K |
| D3230 |
|
49 |
14 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
126 |
$3K |
| D2330 |
|
19 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
95 |
71 |
$747.29 |
| D1354 |
|
77 |
31 |
$362.62 |
| D1999 |
|
2,024 |
1,855 |
$0.00 |