| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,831 |
2,264 |
$1.01M |
| D1351 |
Sealant - per tooth |
17,030 |
4,759 |
$425K |
| D1120 |
Prophylaxis - child |
9,990 |
9,766 |
$338K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,775 |
1,210 |
$272K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,010 |
1,968 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
10,055 |
9,841 |
$271K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,858 |
2,237 |
$240K |
| D0272 |
Bitewings - two radiographic images |
8,855 |
8,595 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,522 |
12,248 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,710 |
1,296 |
$156K |
| D9248 |
|
1,471 |
1,414 |
$152K |
| D0220 |
Intraoral - periapical first radiographic image |
10,947 |
10,499 |
$121K |
| D1110 |
Prophylaxis - adult |
2,232 |
2,185 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,915 |
9,121 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,095 |
4,811 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,114 |
2,055 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,431 |
1,370 |
$46K |
| D0330 |
Panoramic radiographic image |
1,388 |
1,356 |
$43K |
| D9420 |
|
864 |
782 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
417 |
234 |
$20K |
| D2331 |
|
61 |
29 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
249 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
62 |
$4K |
| D7111 |
|
22 |
13 |
$240.87 |
| D0270 |
|
32 |
31 |
$142.10 |
| D3120 |
|
49 |
39 |
$57.34 |
| D0603 |
|
14,138 |
13,911 |
$0.00 |
| D0191 |
|
108 |
106 |
$0.00 |