| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,246 |
1,675 |
$733K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,904 |
3,806 |
$535K |
| D1351 |
Sealant - per tooth |
18,175 |
4,760 |
$450K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,638 |
2,349 |
$447K |
| D0120 |
Periodic oral evaluation - established patient |
15,380 |
15,099 |
$427K |
| D1120 |
Prophylaxis - child |
12,104 |
11,860 |
$424K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,888 |
2,265 |
$288K |
| D9248 |
|
2,195 |
2,150 |
$248K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,627 |
16,300 |
$235K |
| D1110 |
Prophylaxis - adult |
4,038 |
3,957 |
$211K |
| D0220 |
Intraoral - periapical first radiographic image |
17,849 |
17,397 |
$200K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,454 |
16,043 |
$200K |
| D0274 |
Bitewings - four radiographic images |
5,606 |
5,510 |
$183K |
| D0272 |
Bitewings - two radiographic images |
5,092 |
4,967 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,722 |
1,074 |
$87K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
905 |
386 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,712 |
2,657 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
991 |
991 |
$65K |
| D0330 |
Panoramic radiographic image |
2,476 |
2,429 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,000 |
968 |
$33K |
| D2332 |
|
292 |
179 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,333 |
1,291 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
174 |
122 |
$18K |
| D2330 |
|
53 |
40 |
$4K |
| D0603 |
|
11,118 |
10,921 |
$0.00 |
| D0602 |
|
2,738 |
2,693 |
$0.00 |
| D0601 |
|
6,040 |
5,910 |
$0.00 |