| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,079 |
4,271 |
$2.84M |
| D1351 |
Sealant - per tooth |
44,034 |
8,651 |
$1.93M |
| D1120 |
Prophylaxis - child |
27,831 |
27,449 |
$1.52M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,178 |
3,436 |
$1.23M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,818 |
2,702 |
$1.20M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,774 |
3,179 |
$1.17M |
| D1206 |
Topical application of fluoride varnish |
33,453 |
32,943 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
23,405 |
23,009 |
$1.02M |
| D0240 |
|
24,896 |
12,616 |
$775K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,158 |
9,149 |
$661K |
| D2940 |
|
4,656 |
1,838 |
$643K |
| D1110 |
Prophylaxis - adult |
6,861 |
6,748 |
$453K |
| D0272 |
Bitewings - two radiographic images |
12,376 |
12,161 |
$450K |
| D0330 |
Panoramic radiographic image |
5,029 |
4,947 |
$407K |
| D2390 |
|
810 |
320 |
$375K |
| D2330 |
|
1,496 |
874 |
$263K |
| D9920 |
|
1,669 |
1,589 |
$240K |
| D0274 |
Bitewings - four radiographic images |
4,429 |
4,355 |
$229K |
| D1354 |
|
3,661 |
1,250 |
$215K |
| D0160 |
|
1,695 |
1,498 |
$184K |
| D0170 |
|
3,138 |
2,969 |
$182K |
| D0140 |
Limited oral evaluation - problem focused |
2,888 |
2,785 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,921 |
3,196 |
$171K |
| D0220 |
Intraoral - periapical first radiographic image |
6,471 |
5,844 |
$160K |
| D0350 |
|
3,871 |
3,716 |
$153K |
| D2331 |
|
423 |
281 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
241 |
193 |
$81K |
| D0145 |
Oral evaluation for a patient under three years of age |
780 |
775 |
$45K |
| D3120 |
|
374 |
282 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
313 |
288 |
$20K |
| D7962 |
|
88 |
63 |
$17K |
| D1510 |
|
80 |
51 |
$13K |
| D2950 |
|
48 |
37 |
$12K |
| D7961 |
|
52 |
38 |
$10K |
| D7960 |
|
124 |
39 |
$6K |
| D2332 |
|
21 |
16 |
$6K |
| D0270 |
|
274 |
272 |
$5K |
| D9440 |
|
36 |
36 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$3K |
| D0603 |
|
38,217 |
36,524 |
$0.00 |
| D9995 |
|
74 |
74 |
$0.00 |
| D9996 |
|
74 |
74 |
$0.00 |
| D1999 |
|
28 |
28 |
$0.00 |