| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,327 |
2,911 |
$2.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,374 |
6,041 |
$1.12M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,125 |
4,141 |
$548K |
| D0120 |
Periodic oral evaluation - established patient |
15,733 |
15,624 |
$447K |
| D1120 |
Prophylaxis - child |
11,820 |
11,746 |
$427K |
| D2934 |
|
2,777 |
993 |
$406K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,611 |
2,594 |
$366K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,314 |
1,509 |
$356K |
| D9248 |
|
2,926 |
2,892 |
$340K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,633 |
17,397 |
$305K |
| D1351 |
Sealant - per tooth |
9,694 |
3,593 |
$263K |
| D0272 |
Bitewings - two radiographic images |
11,129 |
11,013 |
$248K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,511 |
16,397 |
$239K |
| D0220 |
Intraoral - periapical first radiographic image |
18,649 |
18,374 |
$225K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,304 |
8,160 |
$220K |
| D1110 |
Prophylaxis - adult |
3,397 |
3,362 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
1,944 |
1,924 |
$127K |
| D0274 |
Bitewings - four radiographic images |
2,431 |
2,407 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,046 |
591 |
$65K |
| D0160 |
|
3,968 |
3,943 |
$57K |
| D0350 |
|
780 |
772 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
147 |
$5K |
| D2332 |
|
21 |
14 |
$3K |
| D1510 |
|
16 |
13 |
$3K |
| D2330 |
|
33 |
19 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
95 |
$2K |
| D0240 |
|
17 |
13 |
$88.20 |
| D0603 |
|
24,662 |
24,521 |
$0.00 |