| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,939 |
1,085 |
$517K |
| D1120 |
Prophylaxis - child |
10,862 |
10,334 |
$380K |
| D0120 |
Periodic oral evaluation - established patient |
7,051 |
6,783 |
$186K |
| D1206 |
Topical application of fluoride varnish |
10,523 |
10,004 |
$159K |
| D0603 |
|
8,360 |
7,951 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,651 |
2,474 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,523 |
819 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
972 |
465 |
$98K |
| D0272 |
Bitewings - two radiographic images |
4,585 |
4,324 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,701 |
1,661 |
$64K |
| D1351 |
Sealant - per tooth |
3,149 |
913 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,253 |
1,993 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
918 |
551 |
$43K |
| D0240 |
|
3,278 |
1,664 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,408 |
1,349 |
$40K |
| D0330 |
Panoramic radiographic image |
993 |
918 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
308 |
190 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,674 |
2,420 |
$33K |
| D0602 |
|
1,816 |
1,762 |
$30K |
| D1354 |
|
849 |
344 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
449 |
$17K |
| D9310 |
|
188 |
168 |
$10K |
| D2933 |
|
46 |
15 |
$10K |
| D0601 |
|
499 |
459 |
$8K |
| D1110 |
Prophylaxis - adult |
202 |
194 |
$7K |
| D0274 |
Bitewings - four radiographic images |
95 |
87 |
$2K |
| D1330 |
|
6,453 |
6,163 |
$0.10 |
| D1310 |
|
6,434 |
6,151 |
$0.01 |
| D9999 |
Unspecified adjunctive procedure, by report |
52 |
50 |
$0.00 |
| D1320 |
|
59 |
59 |
$0.00 |
| D1999 |
|
610 |
501 |
$0.00 |