| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,269 |
1,150 |
$724K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,654 |
4,625 |
$645K |
| D1120 |
Prophylaxis - child |
12,111 |
12,009 |
$436K |
| D0120 |
Periodic oral evaluation - established patient |
14,846 |
14,717 |
$421K |
| D1351 |
Sealant - per tooth |
15,009 |
2,299 |
$412K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,540 |
12,446 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
2,620 |
2,603 |
$179K |
| D1110 |
Prophylaxis - adult |
3,289 |
3,270 |
$177K |
| D0272 |
Bitewings - two radiographic images |
7,047 |
6,965 |
$160K |
| D0274 |
Bitewings - four radiographic images |
2,380 |
2,371 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
930 |
476 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
6,841 |
6,737 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,567 |
5,216 |
$52K |
| D1206 |
Topical application of fluoride varnish |
3,500 |
3,469 |
$50K |
| D9248 |
|
325 |
323 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
1,011 |
$35K |
| D9420 |
|
831 |
815 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
246 |
139 |
$14K |
| D0330 |
Panoramic radiographic image |
295 |
287 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
696 |
691 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
99 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
166 |
161 |
$4K |
| D0603 |
|
12,035 |
11,973 |
$0.00 |
| D0602 |
|
8,680 |
8,626 |
$0.00 |