| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,421 |
908 |
$620K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,054 |
1,481 |
$402K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,879 |
1,848 |
$258K |
| D1351 |
Sealant - per tooth |
8,126 |
2,276 |
$219K |
| D1120 |
Prophylaxis - child |
5,961 |
5,871 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
6,198 |
6,083 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,906 |
7,764 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,380 |
7,843 |
$108K |
| D0272 |
Bitewings - two radiographic images |
4,996 |
4,883 |
$104K |
| D1110 |
Prophylaxis - adult |
1,947 |
1,900 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
8,410 |
8,155 |
$95K |
| D9248 |
|
875 |
825 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,006 |
509 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,895 |
1,836 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,964 |
1,912 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,526 |
1,436 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
333 |
120 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
385 |
385 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
223 |
113 |
$22K |
| D0330 |
Panoramic radiographic image |
1,610 |
1,575 |
$21K |
| D0350 |
|
1,533 |
1,461 |
$18K |
| D1330 |
|
969 |
919 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
361 |
342 |
$6K |
| D3120 |
|
41 |
28 |
$143.35 |
| D0603 |
|
9,431 |
9,222 |
$0.00 |
| D0601 |
|
100 |
95 |
$0.00 |
| D0602 |
|
430 |
409 |
$0.00 |