| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,250 |
1,004 |
$961K |
| D2934 |
|
2,961 |
553 |
$409K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,868 |
819 |
$369K |
| D0120 |
Periodic oral evaluation - established patient |
12,368 |
12,240 |
$343K |
| D1120 |
Prophylaxis - child |
8,347 |
8,248 |
$293K |
| D1110 |
Prophylaxis - adult |
4,412 |
4,361 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,213 |
13,049 |
$187K |
| D0272 |
Bitewings - two radiographic images |
8,672 |
8,524 |
$178K |
| D0274 |
Bitewings - four radiographic images |
5,069 |
5,005 |
$154K |
| D0145 |
Oral evaluation for a patient under three years of age |
954 |
946 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,133 |
651 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,179 |
665 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
5,590 |
5,426 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,785 |
1,705 |
$57K |
| D1351 |
Sealant - per tooth |
1,943 |
488 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,275 |
3,512 |
$39K |
| D9420 |
|
1,161 |
1,112 |
$38K |
| D0330 |
Panoramic radiographic image |
1,358 |
1,329 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
328 |
119 |
$17K |
| D0350 |
|
1,181 |
1,128 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
78 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
128 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
80 |
78 |
$2K |
| D1330 |
|
28 |
27 |
$282.47 |
| D1999 |
|
756 |
732 |
$0.00 |
| D0603 |
|
17,321 |
17,087 |
$0.00 |