| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,114 |
561 |
$310K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,074 |
1,068 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,325 |
688 |
$135K |
| D1120 |
Prophylaxis - child |
3,662 |
3,607 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,508 |
3,459 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,520 |
4,456 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,727 |
1,711 |
$58K |
| D9248 |
|
465 |
462 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
648 |
280 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,732 |
3,003 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,300 |
2,273 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,550 |
3,462 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
585 |
585 |
$39K |
| D1110 |
Prophylaxis - adult |
688 |
680 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,010 |
995 |
$28K |
| D1351 |
Sealant - per tooth |
917 |
278 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
790 |
743 |
$21K |
| D0350 |
|
3,998 |
3,675 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
170 |
87 |
$14K |
| D0330 |
Panoramic radiographic image |
809 |
804 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
83 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
194 |
187 |
$3K |
| D0170 |
|
158 |
153 |
$2K |
| D7111 |
|
20 |
12 |
$206.46 |
| D0270 |
|
30 |
29 |
$127.40 |
| D0603 |
|
6,364 |
6,282 |
$0.00 |