| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,908 |
782 |
$414K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,056 |
2,044 |
$286K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,701 |
921 |
$171K |
| D1120 |
Prophylaxis - child |
4,126 |
4,088 |
$145K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,420 |
647 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
3,851 |
3,807 |
$107K |
| D9248 |
|
640 |
634 |
$75K |
| D0350 |
|
4,561 |
4,168 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,168 |
5,115 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,924 |
1,911 |
$65K |
| D1351 |
Sealant - per tooth |
2,243 |
669 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,652 |
2,622 |
$59K |
| D1110 |
Prophylaxis - adult |
977 |
963 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,712 |
3,118 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,752 |
3,674 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,200 |
1,184 |
$39K |
| D0330 |
Panoramic radiographic image |
1,044 |
1,032 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
977 |
931 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
167 |
79 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
279 |
273 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
36 |
$3K |
| D1354 |
|
166 |
24 |
$2K |
| D0170 |
|
234 |
223 |
$2K |
| D0270 |
|
12 |
12 |
$58.80 |
| D0603 |
|
7,993 |
7,906 |
$0.00 |