| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,317 |
2,322 |
$771K |
| D1120 |
Prophylaxis - child |
24,796 |
19,923 |
$613K |
| D0120 |
Periodic oral evaluation - established patient |
25,226 |
20,278 |
$524K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,601 |
2,320 |
$400K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,370 |
18,817 |
$361K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,430 |
1,787 |
$336K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,371 |
2,158 |
$252K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,427 |
1,786 |
$222K |
| D0272 |
Bitewings - two radiographic images |
14,173 |
11,399 |
$189K |
| D0330 |
Panoramic radiographic image |
2,170 |
1,754 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,950 |
3,266 |
$119K |
| D1206 |
Topical application of fluoride varnish |
3,711 |
2,946 |
$107K |
| D1110 |
Prophylaxis - adult |
2,503 |
2,066 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,117 |
1,657 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,621 |
3,394 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
6,594 |
5,416 |
$47K |
| D2330 |
|
225 |
102 |
$12K |
| D2140 |
|
146 |
80 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
63 |
$3K |
| D2335 |
|
24 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$519.70 |
| D1999 |
|
786 |
704 |
$0.00 |