| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,701 |
969 |
$507K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,614 |
2,593 |
$359K |
| D1120 |
Prophylaxis - child |
8,463 |
8,332 |
$284K |
| D1351 |
Sealant - per tooth |
9,234 |
2,124 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
8,367 |
8,231 |
$224K |
| D0272 |
Bitewings - two radiographic images |
6,257 |
6,157 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,812 |
6,373 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,312 |
796 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,404 |
813 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,988 |
6,883 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
7,932 |
7,661 |
$82K |
| D9248 |
|
717 |
698 |
$77K |
| D1110 |
Prophylaxis - adult |
1,196 |
1,178 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,695 |
1,645 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,847 |
1,748 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,593 |
1,567 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,400 |
2,358 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
397 |
172 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
506 |
301 |
$27K |
| D0330 |
Panoramic radiographic image |
425 |
418 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
212 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
292 |
288 |
$5K |
| D0350 |
|
45 |
43 |
$36.76 |
| D0603 |
|
13,541 |
13,384 |
$0.00 |