| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,734 |
1,479 |
$833K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,476 |
2,397 |
$532K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,032 |
2,029 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
9,673 |
9,629 |
$275K |
| D1120 |
Prophylaxis - child |
7,378 |
7,347 |
$266K |
| D1351 |
Sealant - per tooth |
9,767 |
2,674 |
$265K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,336 |
1,153 |
$179K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,201 |
9,996 |
$169K |
| D9248 |
|
1,410 |
1,380 |
$166K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,868 |
10,817 |
$157K |
| D1110 |
Prophylaxis - adult |
2,829 |
2,812 |
$152K |
| D0210 |
Intraoral - complete series of radiographic images |
2,064 |
2,052 |
$138K |
| D0274 |
Bitewings - four radiographic images |
3,832 |
3,808 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
10,681 |
10,583 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,082 |
3,991 |
$107K |
| D0272 |
Bitewings - two radiographic images |
3,996 |
3,980 |
$90K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
808 |
316 |
$66K |
| D2934 |
|
252 |
98 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
910 |
$31K |
| D0160 |
|
1,705 |
1,697 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
40 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
52 |
$4K |
| D7111 |
|
376 |
232 |
$4K |
| D1330 |
|
328 |
327 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
169 |
$3K |
| D0603 |
|
15,578 |
15,527 |
$0.00 |
| D0601 |
|
18 |
18 |
$0.00 |