| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,947 |
1,053 |
$406K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,184 |
1,786 |
$379K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,688 |
2,672 |
$365K |
| D1351 |
Sealant - per tooth |
11,760 |
2,449 |
$301K |
| D1120 |
Prophylaxis - child |
7,629 |
7,525 |
$263K |
| D9248 |
|
2,243 |
2,182 |
$248K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,415 |
6,464 |
$199K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,232 |
791 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,257 |
6,177 |
$171K |
| D1206 |
Topical application of fluoride varnish |
8,224 |
8,107 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,409 |
774 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
7,298 |
7,105 |
$86K |
| D0272 |
Bitewings - two radiographic images |
2,990 |
2,951 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,915 |
1,879 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,098 |
580 |
$62K |
| D1110 |
Prophylaxis - adult |
733 |
729 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,806 |
1,747 |
$31K |
| D1330 |
|
2,830 |
2,756 |
$26K |
| D0330 |
Panoramic radiographic image |
426 |
423 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
953 |
924 |
$24K |
| D0274 |
Bitewings - four radiographic images |
476 |
466 |
$15K |
| D2330 |
|
140 |
80 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
93 |
91 |
$1K |
| D1999 |
|
12 |
12 |
$0.00 |
| D0603 |
|
11,292 |
11,175 |
$0.00 |