| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,283 |
3,520 |
$1.75M |
| D1120 |
Prophylaxis - child |
32,149 |
29,521 |
$949K |
| D1206 |
Topical application of fluoride varnish |
37,511 |
34,434 |
$702K |
| D0120 |
Periodic oral evaluation - established patient |
30,805 |
28,308 |
$603K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,523 |
2,641 |
$418K |
| D0272 |
Bitewings - two radiographic images |
15,728 |
14,334 |
$323K |
| D0330 |
Panoramic radiographic image |
5,666 |
5,217 |
$296K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,026 |
7,336 |
$237K |
| D1110 |
Prophylaxis - adult |
5,824 |
5,341 |
$234K |
| D1351 |
Sealant - per tooth |
11,163 |
3,180 |
$232K |
| D1354 |
|
2,872 |
1,159 |
$189K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,108 |
1,904 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,472 |
6,406 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,332 |
2,661 |
$178K |
| D2934 |
|
1,159 |
404 |
$152K |
| D1510 |
|
956 |
532 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
10,001 |
8,906 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
2,832 |
2,523 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,810 |
2,552 |
$78K |
| D7111 |
|
1,031 |
589 |
$64K |
| D2330 |
|
551 |
307 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,394 |
896 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
109 |
79 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
77 |
$3K |
| D2332 |
|
19 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$331.37 |