| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,557 |
1,042 |
$784K |
| D1120 |
Prophylaxis - child |
7,050 |
6,905 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
6,078 |
5,974 |
$168K |
| D0272 |
Bitewings - two radiographic images |
7,644 |
7,484 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,555 |
3,451 |
$118K |
| D1351 |
Sealant - per tooth |
4,519 |
1,347 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,071 |
7,917 |
$115K |
| D9248 |
|
548 |
512 |
$62K |
| D0145 |
Oral evaluation for a patient under three years of age |
369 |
368 |
$51K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
571 |
194 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
238 |
$41K |
| D1110 |
Prophylaxis - adult |
798 |
774 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,565 |
2,504 |
$30K |
| D0274 |
Bitewings - four radiographic images |
936 |
911 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
227 |
142 |
$16K |
| D9420 |
|
400 |
388 |
$14K |
| D0330 |
Panoramic radiographic image |
184 |
182 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
53 |
$6K |
| D2934 |
|
34 |
12 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
172 |
161 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
166 |
123 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$216.50 |
| D0603 |
|
11,518 |
11,274 |
$0.00 |