| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,696 |
6,549 |
$3.35M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,359 |
7,944 |
$1.56M |
| D1120 |
Prophylaxis - child |
37,447 |
35,478 |
$1.15M |
| D1206 |
Topical application of fluoride varnish |
50,314 |
47,622 |
$996K |
| D0120 |
Periodic oral evaluation - established patient |
37,806 |
35,907 |
$784K |
| D1110 |
Prophylaxis - adult |
13,477 |
12,721 |
$550K |
| D1351 |
Sealant - per tooth |
17,162 |
4,620 |
$445K |
| D1354 |
|
5,584 |
1,967 |
$443K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,149 |
13,346 |
$432K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,446 |
14,070 |
$401K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,721 |
5,163 |
$360K |
| D0272 |
Bitewings - two radiographic images |
16,190 |
15,300 |
$332K |
| D0140 |
Limited oral evaluation - problem focused |
12,277 |
11,130 |
$321K |
| D0330 |
Panoramic radiographic image |
5,222 |
4,947 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,207 |
3,191 |
$245K |
| D2330 |
|
2,670 |
1,651 |
$168K |
| D1510 |
|
993 |
594 |
$145K |
| D0240 |
|
10,891 |
7,631 |
$139K |
| D0274 |
Bitewings - four radiographic images |
4,239 |
3,998 |
$124K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,414 |
6,205 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
11,348 |
10,365 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
5,441 |
3,184 |
$80K |
| D2390 |
|
645 |
231 |
$74K |
| D2331 |
|
536 |
357 |
$40K |
| D1352 |
|
1,338 |
789 |
$34K |
| D2931 |
|
149 |
70 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
564 |
515 |
$15K |
| D0170 |
|
700 |
668 |
$12K |
| D9248 |
|
458 |
421 |
$11K |
| D2335 |
|
22 |
13 |
$3K |
| D2332 |
|
14 |
12 |
$1K |
| D2940 |
|
12 |
12 |
$729.36 |
| D9971 |
|
80 |
57 |
$0.00 |