| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,612 |
2,297 |
$1.33M |
| D0145 |
Oral evaluation for a patient under three years of age |
7,000 |
6,871 |
$954K |
| D1120 |
Prophylaxis - child |
24,841 |
24,639 |
$845K |
| D0120 |
Periodic oral evaluation - established patient |
28,471 |
28,205 |
$794K |
| D1351 |
Sealant - per tooth |
26,066 |
6,686 |
$651K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,239 |
3,626 |
$560K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,360 |
4,320 |
$536K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,190 |
30,855 |
$430K |
| D1110 |
Prophylaxis - adult |
6,867 |
6,815 |
$362K |
| D0272 |
Bitewings - two radiographic images |
15,731 |
15,540 |
$331K |
| D0274 |
Bitewings - four radiographic images |
7,155 |
7,053 |
$209K |
| D0330 |
Panoramic radiographic image |
5,517 |
5,420 |
$187K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,425 |
6,282 |
$161K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,107 |
1,436 |
$160K |
| D9248 |
|
1,409 |
1,383 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
10,961 |
10,720 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,318 |
7,132 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,007 |
2,934 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,186 |
472 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,229 |
1,229 |
$80K |
| D9420 |
|
1,474 |
1,443 |
$51K |
| D2934 |
|
270 |
82 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
715 |
699 |
$13K |
| D0170 |
|
1,447 |
1,416 |
$8K |
| D1206 |
Topical application of fluoride varnish |
351 |
348 |
$5K |
| D2330 |
|
49 |
28 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
16 |
12 |
$660.72 |
| D0350 |
|
99 |
56 |
$623.08 |
| D1999 |
|
10,285 |
9,797 |
$0.00 |
| D0603 |
|
36,839 |
36,442 |
$0.00 |
| D0601 |
|
2,613 |
2,588 |
$0.00 |