| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,994 |
1,555 |
$1.00M |
| D1120 |
Prophylaxis - child |
16,338 |
15,707 |
$442K |
| D0120 |
Periodic oral evaluation - established patient |
16,928 |
16,247 |
$434K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,652 |
2,191 |
$383K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,856 |
2,347 |
$374K |
| D1206 |
Topical application of fluoride varnish |
19,705 |
18,970 |
$307K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,227 |
3,984 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,512 |
3,332 |
$152K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,183 |
1,004 |
$137K |
| D1351 |
Sealant - per tooth |
5,111 |
1,614 |
$131K |
| D1110 |
Prophylaxis - adult |
3,424 |
3,307 |
$129K |
| D9420 |
|
1,084 |
1,011 |
$126K |
| D0272 |
Bitewings - two radiographic images |
7,147 |
6,853 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
4,570 |
4,331 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,881 |
2,809 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
589 |
291 |
$49K |
| D0330 |
Panoramic radiographic image |
774 |
750 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
765 |
726 |
$28K |
| D2390 |
|
154 |
45 |
$25K |
| D0274 |
Bitewings - four radiographic images |
695 |
661 |
$22K |
| D0240 |
|
1,334 |
700 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
310 |
306 |
$11K |
| D2330 |
|
146 |
76 |
$9K |
| D2332 |
|
20 |
13 |
$2K |
| D1354 |
|
32 |
14 |
$242.00 |
| D9248 |
|
570 |
536 |
$0.00 |
| D1999 |
|
1,298 |
1,231 |
$0.00 |