| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,664 |
1,382 |
$520K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,084 |
2,988 |
$486K |
| D1120 |
Prophylaxis - child |
9,437 |
9,303 |
$332K |
| D0120 |
Periodic oral evaluation - established patient |
11,449 |
11,311 |
$320K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,341 |
2,300 |
$319K |
| D0272 |
Bitewings - two radiographic images |
9,172 |
9,041 |
$208K |
| D9248 |
|
1,632 |
1,541 |
$171K |
| D1351 |
Sealant - per tooth |
6,230 |
1,710 |
$164K |
| D1110 |
Prophylaxis - adult |
3,107 |
3,076 |
$164K |
| D0220 |
Intraoral - periapical first radiographic image |
13,117 |
12,872 |
$159K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,929 |
12,302 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,736 |
1,164 |
$125K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,091 |
3,801 |
$104K |
| D0274 |
Bitewings - four radiographic images |
2,940 |
2,907 |
$99K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,253 |
585 |
$98K |
| D1206 |
Topical application of fluoride varnish |
6,905 |
6,826 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,417 |
5,336 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,130 |
686 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,667 |
1,624 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,015 |
983 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
216 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
37 |
$4K |
| D2934 |
|
31 |
12 |
$3K |
| D2331 |
|
17 |
12 |
$2K |
| D2330 |
|
18 |
14 |
$1K |
| D0603 |
|
14,699 |
14,500 |
$0.00 |
| D0602 |
|
97 |
96 |
$0.00 |
| D0601 |
|
655 |
645 |
$0.00 |