| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,323 |
943 |
$469K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,137 |
3,118 |
$435K |
| D1351 |
Sealant - per tooth |
15,119 |
2,931 |
$412K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,784 |
1,790 |
$357K |
| D1120 |
Prophylaxis - child |
7,111 |
7,031 |
$248K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,545 |
7,047 |
$237K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,998 |
1,077 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
5,293 |
5,236 |
$146K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,566 |
484 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,626 |
3,579 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
1,753 |
1,746 |
$119K |
| D1206 |
Topical application of fluoride varnish |
8,075 |
7,983 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
7,840 |
7,679 |
$90K |
| D9248 |
|
604 |
595 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,383 |
2,299 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
978 |
488 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,982 |
1,960 |
$43K |
| D1110 |
Prophylaxis - adult |
656 |
652 |
$34K |
| D1330 |
|
3,402 |
3,318 |
$31K |
| D2934 |
|
149 |
44 |
$21K |
| D0274 |
Bitewings - four radiographic images |
556 |
552 |
$19K |
| D0350 |
|
902 |
882 |
$11K |
| D2330 |
|
50 |
28 |
$4K |
| D2332 |
|
28 |
16 |
$4K |
| D0330 |
Panoramic radiographic image |
165 |
160 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
85 |
85 |
$2K |
| D0603 |
|
12,348 |
12,237 |
$0.00 |