| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,958 |
527 |
$406K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,652 |
2,607 |
$365K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,606 |
1,468 |
$353K |
| D1351 |
Sealant - per tooth |
9,455 |
2,298 |
$251K |
| D1120 |
Prophylaxis - child |
6,511 |
6,347 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
7,394 |
7,175 |
$203K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,944 |
957 |
$145K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,692 |
6,960 |
$136K |
| D1110 |
Prophylaxis - adult |
2,605 |
2,536 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,162 |
8,921 |
$128K |
| D0274 |
Bitewings - four radiographic images |
3,349 |
3,261 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
7,900 |
7,622 |
$92K |
| D0330 |
Panoramic radiographic image |
1,889 |
1,843 |
$70K |
| D9248 |
|
597 |
560 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,906 |
1,847 |
$63K |
| D0272 |
Bitewings - two radiographic images |
4,067 |
3,950 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,989 |
1,894 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
574 |
571 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
296 |
158 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
595 |
567 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
83 |
39 |
$7K |
| D2330 |
|
82 |
54 |
$6K |
| D2332 |
|
21 |
13 |
$3K |
| D7111 |
|
25 |
12 |
$275.28 |
| D0603 |
|
12,024 |
11,814 |
$0.00 |