| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,618 |
1,198 |
$791K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,871 |
4,809 |
$677K |
| D1351 |
Sealant - per tooth |
23,193 |
3,681 |
$639K |
| D1120 |
Prophylaxis - child |
13,892 |
13,795 |
$495K |
| D0120 |
Periodic oral evaluation - established patient |
15,629 |
15,494 |
$439K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,907 |
14,744 |
$421K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,280 |
1,530 |
$321K |
| D1206 |
Topical application of fluoride varnish |
17,930 |
17,800 |
$256K |
| D0210 |
Intraoral - complete series of radiographic images |
3,537 |
3,517 |
$239K |
| D1110 |
Prophylaxis - adult |
4,515 |
4,480 |
$238K |
| D0220 |
Intraoral - periapical first radiographic image |
15,505 |
15,347 |
$188K |
| D7240 |
Removal of impacted tooth - completely bony |
556 |
187 |
$157K |
| D0274 |
Bitewings - four radiographic images |
4,131 |
4,093 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,761 |
982 |
$122K |
| D0272 |
Bitewings - two radiographic images |
4,863 |
4,824 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,999 |
2,966 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,756 |
2,658 |
$72K |
| D9248 |
|
294 |
285 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
546 |
258 |
$32K |
| D9420 |
|
433 |
427 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
757 |
753 |
$14K |
| D1330 |
|
567 |
564 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
200 |
200 |
$3K |
| D0603 |
|
5,608 |
5,552 |
$0.00 |
| D0602 |
|
19,217 |
19,050 |
$0.00 |