| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,840 |
966 |
$409K |
| D1351 |
Sealant - per tooth |
13,811 |
2,880 |
$368K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,961 |
8,922 |
$333K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,174 |
1,574 |
$312K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,158 |
2,137 |
$298K |
| D1120 |
Prophylaxis - child |
6,750 |
6,695 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
6,614 |
6,543 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,818 |
8,735 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
9,447 |
9,315 |
$113K |
| D1110 |
Prophylaxis - adult |
1,927 |
1,903 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,516 |
2,460 |
$83K |
| D0272 |
Bitewings - two radiographic images |
3,092 |
3,066 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,964 |
1,938 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,720 |
1,659 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
669 |
393 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
376 |
244 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
316 |
138 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
525 |
523 |
$9K |
| D9248 |
|
73 |
72 |
$9K |
| D0603 |
|
11,446 |
11,347 |
$0.08 |
| D0602 |
|
25 |
25 |
$0.00 |