| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,831 |
624 |
$255K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,459 |
1,446 |
$203K |
| D1351 |
Sealant - per tooth |
6,772 |
1,617 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
5,749 |
5,680 |
$161K |
| D1120 |
Prophylaxis - child |
4,312 |
4,242 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,758 |
975 |
$132K |
| D0272 |
Bitewings - two radiographic images |
5,630 |
5,552 |
$121K |
| D9248 |
|
1,003 |
896 |
$114K |
| D1110 |
Prophylaxis - adult |
1,735 |
1,718 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,104 |
6,019 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
806 |
566 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,072 |
4,988 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,984 |
4,874 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,405 |
1,341 |
$37K |
| D0330 |
Panoramic radiographic image |
815 |
807 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
437 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
162 |
$11K |
| D0350 |
|
275 |
253 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
135 |
$3K |
| D0601 |
|
1,964 |
1,942 |
$0.00 |
| D0603 |
|
5,951 |
5,911 |
$0.00 |
| D0602 |
|
55 |
55 |
$0.00 |
| D9987 |
|
118 |
117 |
$0.00 |
| D9986 |
|
460 |
454 |
$0.00 |