| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,697 |
3,670 |
$2.50M |
| D0145 |
Oral evaluation for a patient under three years of age |
5,112 |
5,058 |
$712K |
| D0120 |
Periodic oral evaluation - established patient |
21,812 |
21,584 |
$607K |
| D1120 |
Prophylaxis - child |
14,797 |
14,648 |
$522K |
| D9248 |
|
3,932 |
3,831 |
$458K |
| D1110 |
Prophylaxis - adult |
7,772 |
7,691 |
$407K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,717 |
2,943 |
$343K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,745 |
22,513 |
$322K |
| D1351 |
Sealant - per tooth |
12,609 |
3,466 |
$322K |
| D0272 |
Bitewings - two radiographic images |
13,971 |
13,713 |
$280K |
| D0274 |
Bitewings - four radiographic images |
8,924 |
8,822 |
$265K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,370 |
2,135 |
$265K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,749 |
1,737 |
$214K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,095 |
992 |
$164K |
| D0220 |
Intraoral - periapical first radiographic image |
14,180 |
13,755 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,564 |
1,028 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,327 |
10,327 |
$136K |
| D2140 |
|
2,200 |
1,397 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,774 |
3,704 |
$126K |
| D2160 |
|
1,246 |
879 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
1,874 |
1,873 |
$118K |
| D0350 |
|
8,635 |
8,371 |
$107K |
| D0330 |
Panoramic radiographic image |
4,332 |
4,285 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,650 |
3,570 |
$93K |
| D9420 |
|
1,950 |
1,898 |
$67K |
| D2934 |
|
217 |
62 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,440 |
1,415 |
$26K |
| D1330 |
|
701 |
694 |
$8K |
| D1510 |
|
36 |
27 |
$5K |
| D7111 |
|
213 |
145 |
$2K |
| D2330 |
|
25 |
15 |
$2K |
| D3120 |
|
37 |
28 |
$57.34 |
| D0603 |
|
31,248 |
30,923 |
$0.00 |