| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,339 |
2,550 |
$1.10M |
| D1120 |
Prophylaxis - child |
16,059 |
15,747 |
$478K |
| D0120 |
Periodic oral evaluation - established patient |
15,527 |
15,244 |
$356K |
| D1206 |
Topical application of fluoride varnish |
11,366 |
11,082 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,478 |
1,522 |
$141K |
| D0272 |
Bitewings - two radiographic images |
8,692 |
8,516 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,813 |
6,731 |
$124K |
| D1351 |
Sealant - per tooth |
3,272 |
942 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,031 |
2,912 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
6,820 |
6,564 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
3,469 |
3,388 |
$77K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
898 |
353 |
$71K |
| D0330 |
Panoramic radiographic image |
1,194 |
1,173 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,238 |
4,354 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
787 |
330 |
$42K |
| D1110 |
Prophylaxis - adult |
713 |
700 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
371 |
259 |
$26K |
| D2140 |
|
228 |
125 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
433 |
424 |
$12K |
| D2934 |
|
109 |
38 |
$12K |
| D2330 |
|
33 |
27 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
80 |
79 |
$2K |
| D0274 |
Bitewings - four radiographic images |
66 |
62 |
$2K |
| D9420 |
|
1,489 |
1,441 |
$398.88 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$249.56 |