| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,312 |
2,302 |
$626K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,706 |
2,314 |
$430K |
| D1120 |
Prophylaxis - child |
8,822 |
8,729 |
$370K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,250 |
1,988 |
$350K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,669 |
1,723 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
8,122 |
8,055 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,248 |
10,142 |
$204K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,330 |
1,199 |
$170K |
| D0330 |
Panoramic radiographic image |
1,564 |
1,543 |
$94K |
| D1110 |
Prophylaxis - adult |
1,473 |
1,455 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,607 |
3,527 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,956 |
1,933 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,195 |
1,172 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,450 |
1,340 |
$29K |
| D0240 |
|
1,601 |
909 |
$24K |
| D1351 |
Sealant - per tooth |
973 |
357 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
630 |
625 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,204 |
1,172 |
$15K |
| D9248 |
|
377 |
329 |
$13K |
| D1206 |
Topical application of fluoride varnish |
268 |
263 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
345 |
318 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
71 |
$2K |
| D0602 |
|
1,254 |
1,242 |
$0.00 |
| D0601 |
|
338 |
333 |
$0.00 |
| D0603 |
|
92 |
91 |
$0.00 |