| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,559 |
1,189 |
$645K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,788 |
2,729 |
$382K |
| D1351 |
Sealant - per tooth |
12,093 |
3,683 |
$327K |
| D1120 |
Prophylaxis - child |
8,191 |
8,079 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
9,330 |
9,215 |
$263K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,230 |
1,243 |
$212K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,436 |
1,580 |
$183K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,087 |
9,111 |
$176K |
| D9248 |
|
1,364 |
1,313 |
$158K |
| D1206 |
Topical application of fluoride varnish |
9,335 |
9,228 |
$134K |
| D0272 |
Bitewings - two radiographic images |
5,731 |
5,630 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
9,860 |
9,617 |
$119K |
| D1110 |
Prophylaxis - adult |
1,857 |
1,841 |
$99K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,117 |
437 |
$88K |
| D0330 |
Panoramic radiographic image |
1,209 |
1,199 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,650 |
1,634 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
708 |
409 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,450 |
1,398 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,415 |
1,380 |
$26K |
| D2934 |
|
115 |
38 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
449 |
439 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
419 |
406 |
$6K |
| D0350 |
|
76 |
76 |
$827.10 |
| D0603 |
|
12,836 |
12,652 |
$0.00 |