| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,596 |
3,269 |
$1.58M |
| D0145 |
Oral evaluation for a patient under three years of age |
4,841 |
4,826 |
$670K |
| D1120 |
Prophylaxis - child |
13,930 |
13,793 |
$486K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,330 |
18,071 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
13,291 |
13,184 |
$366K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,246 |
17,069 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,358 |
1,646 |
$240K |
| D1351 |
Sealant - per tooth |
8,427 |
1,466 |
$218K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,285 |
1,259 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
19,536 |
19,180 |
$195K |
| D0272 |
Bitewings - two radiographic images |
9,644 |
9,544 |
$190K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,128 |
998 |
$163K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,047 |
5,120 |
$157K |
| D1110 |
Prophylaxis - adult |
3,009 |
2,984 |
$157K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,511 |
1,343 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,066 |
3,996 |
$133K |
| D0274 |
Bitewings - four radiographic images |
3,098 |
3,072 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,346 |
1,346 |
$87K |
| D0330 |
Panoramic radiographic image |
3,185 |
3,137 |
$70K |
| D9420 |
|
983 |
952 |
$33K |
| D2933 |
|
273 |
83 |
$33K |
| D9248 |
|
278 |
274 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,400 |
1,370 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
47 |
$7K |
| D2330 |
|
38 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$333.69 |
| D0603 |
|
8,329 |
8,202 |
$0.00 |
| D0601 |
|
5,062 |
5,047 |
$0.00 |
| D0602 |
|
8,863 |
8,762 |
$0.00 |