| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,169 |
1,657 |
$578K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,978 |
3,937 |
$546K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,327 |
2,845 |
$498K |
| D1351 |
Sealant - per tooth |
18,406 |
4,374 |
$489K |
| D1120 |
Prophylaxis - child |
12,122 |
11,967 |
$425K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,029 |
13,425 |
$399K |
| D0120 |
Periodic oral evaluation - established patient |
12,117 |
11,970 |
$339K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,410 |
14,224 |
$204K |
| D0220 |
Intraoral - periapical first radiographic image |
14,913 |
14,506 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,373 |
1,501 |
$173K |
| D9248 |
|
1,351 |
1,297 |
$147K |
| D1110 |
Prophylaxis - adult |
2,317 |
2,292 |
$121K |
| D0272 |
Bitewings - two radiographic images |
4,868 |
4,806 |
$110K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,126 |
509 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,736 |
2,619 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,349 |
3,159 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,448 |
2,421 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
890 |
877 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
892 |
585 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,252 |
1,224 |
$23K |
| D1330 |
|
1,532 |
1,491 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
43 |
$5K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$405.16 |
| D0350 |
|
32 |
32 |
$402.52 |
| D7111 |
|
18 |
13 |
$194.99 |
| D0603 |
|
11,092 |
10,965 |
$0.00 |
| D0602 |
|
7,691 |
7,608 |
$0.00 |
| D0601 |
|
125 |
124 |
$0.00 |