| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,630 |
3,222 |
$1.16M |
| D1120 |
Prophylaxis - child |
16,666 |
15,535 |
$488K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,106 |
4,719 |
$429K |
| D1351 |
Sealant - per tooth |
17,105 |
4,753 |
$394K |
| D1206 |
Topical application of fluoride varnish |
20,111 |
18,749 |
$375K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,160 |
10,685 |
$336K |
| D0120 |
Periodic oral evaluation - established patient |
17,064 |
15,930 |
$328K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,776 |
2,341 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,859 |
2,753 |
$191K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,053 |
7,271 |
$164K |
| D1510 |
|
934 |
737 |
$153K |
| D1110 |
Prophylaxis - adult |
3,366 |
3,144 |
$142K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,394 |
945 |
$138K |
| D2390 |
|
1,019 |
355 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,432 |
3,179 |
$107K |
| D2331 |
|
1,198 |
785 |
$100K |
| D0272 |
Bitewings - two radiographic images |
5,186 |
4,723 |
$98K |
| D0330 |
Panoramic radiographic image |
2,497 |
2,312 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
9,070 |
8,268 |
$90K |
| D2330 |
|
1,342 |
790 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
3,422 |
2,275 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
2,333 |
2,155 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,487 |
1,382 |
$43K |
| D2332 |
|
315 |
200 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
301 |
273 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
638 |
607 |
$20K |
| D7111 |
|
173 |
111 |
$12K |
| D0273 |
|
14 |
13 |
$305.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
54 |
$134.34 |
| D1353 |
|
692 |
333 |
$0.00 |
| D1352 |
|
18 |
12 |
$0.00 |
| D9420 |
|
83 |
68 |
$0.00 |
| D3120 |
|
158 |
118 |
$0.00 |