| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,464 |
5,743 |
$2.90M |
| D1120 |
Prophylaxis - child |
33,216 |
32,982 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
33,917 |
33,671 |
$1.33M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,718 |
5,466 |
$1.05M |
| D1208 |
Topical application of fluoride, excluding varnish |
29,219 |
29,017 |
$842K |
| D0272 |
Bitewings - two radiographic images |
19,465 |
19,339 |
$664K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,925 |
3,546 |
$429K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,927 |
1,715 |
$264K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,036 |
10,469 |
$251K |
| D1110 |
Prophylaxis - adult |
3,914 |
3,876 |
$249K |
| D1206 |
Topical application of fluoride varnish |
5,300 |
5,242 |
$227K |
| D0240 |
|
6,465 |
4,554 |
$221K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,608 |
1,500 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,204 |
4,169 |
$183K |
| D2332 |
|
1,181 |
645 |
$151K |
| D1351 |
Sealant - per tooth |
4,227 |
1,528 |
$144K |
| D0330 |
Panoramic radiographic image |
1,379 |
1,367 |
$135K |
| D1330 |
|
2,588 |
2,530 |
$108K |
| D0274 |
Bitewings - four radiographic images |
1,725 |
1,716 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
1,413 |
1,389 |
$69K |
| D2330 |
|
1,067 |
566 |
$60K |
| D3240 |
|
638 |
410 |
$59K |
| D1310 |
|
1,478 |
1,464 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,540 |
2,492 |
$52K |
| D2933 |
|
331 |
118 |
$50K |
| D3230 |
|
255 |
88 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
486 |
480 |
$25K |
| D9420 |
|
1,111 |
1,095 |
$18K |
| D1510 |
|
125 |
109 |
$13K |
| D2331 |
|
258 |
157 |
$10K |
| D2335 |
|
60 |
41 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
40 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
83 |
57 |
$1K |
| D2920 |
|
12 |
12 |
$719.46 |
| D9430 |
|
28 |
27 |
$399.55 |
| D9920 |
|
13 |
13 |
$276.15 |
| D9985 |
|
37 |
31 |
$0.00 |
| D9995 |
|
14 |
12 |
$0.00 |
| D9996 |
|
18 |
18 |
$0.00 |