| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,805 |
4,401 |
$980K |
| D0120 |
Periodic oral evaluation - established patient |
32,254 |
31,542 |
$834K |
| D2140 |
|
11,538 |
5,918 |
$831K |
| D1120 |
Prophylaxis - child |
26,331 |
25,597 |
$713K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,931 |
14,980 |
$711K |
| D1206 |
Topical application of fluoride varnish |
33,670 |
32,753 |
$547K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,756 |
3,718 |
$509K |
| D1351 |
Sealant - per tooth |
17,358 |
4,841 |
$480K |
| D1110 |
Prophylaxis - adult |
12,143 |
11,816 |
$461K |
| D0220 |
Intraoral - periapical first radiographic image |
21,013 |
20,311 |
$315K |
| D0330 |
Panoramic radiographic image |
5,870 |
5,702 |
$274K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,321 |
2,216 |
$261K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,519 |
2,473 |
$225K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,119 |
4,926 |
$223K |
| D0272 |
Bitewings - two radiographic images |
12,007 |
11,708 |
$214K |
| D0274 |
Bitewings - four radiographic images |
6,518 |
6,330 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,081 |
1,604 |
$201K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,908 |
1,501 |
$179K |
| D1510 |
|
830 |
735 |
$160K |
| D0140 |
Limited oral evaluation - problem focused |
2,277 |
2,198 |
$84K |
| D2332 |
|
773 |
526 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,393 |
4,935 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,221 |
4,136 |
$64K |
| D2330 |
|
814 |
561 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,929 |
1,031 |
$38K |
| D2934 |
|
190 |
89 |
$35K |
| D7111 |
|
406 |
295 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
174 |
146 |
$20K |
| D2331 |
|
155 |
122 |
$13K |
| D2335 |
|
61 |
41 |
$8K |
| D0350 |
|
9,464 |
9,045 |
$3K |
| D1354 |
|
159 |
65 |
$1K |
| D9440 |
|
15 |
13 |
$834.73 |
| D1999 |
|
693 |
648 |
$0.00 |