| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,862 |
1,323 |
$580K |
| D8670 |
Periodic orthodontic treatment visit |
957 |
939 |
$369K |
| D1120 |
Prophylaxis - child |
8,630 |
8,503 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,404 |
10,241 |
$222K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,897 |
1,957 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
8,682 |
8,552 |
$211K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,561 |
1,520 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,905 |
1,837 |
$205K |
| D1351 |
Sealant - per tooth |
5,736 |
2,052 |
$186K |
| D2335 |
|
712 |
326 |
$105K |
| D1110 |
Prophylaxis - adult |
1,920 |
1,885 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,555 |
2,515 |
$92K |
| D0330 |
Panoramic radiographic image |
1,373 |
1,337 |
$78K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
720 |
437 |
$70K |
| D0272 |
Bitewings - two radiographic images |
4,663 |
4,593 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
498 |
496 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,645 |
1,543 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
988 |
968 |
$32K |
| D0274 |
Bitewings - four radiographic images |
870 |
858 |
$26K |
| D1510 |
|
144 |
120 |
$26K |
| D0340 |
|
250 |
243 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,993 |
2,917 |
$22K |
| D8680 |
|
54 |
27 |
$21K |
| D2933 |
|
60 |
13 |
$17K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
15 |
15 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,742 |
1,507 |
$13K |
| D2330 |
|
91 |
57 |
$6K |
| D0350 |
|
240 |
233 |
$4K |
| D2332 |
|
18 |
12 |
$3K |
| D0240 |
|
159 |
77 |
$2K |
| D0270 |
|
12 |
12 |
$60.00 |