| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,496 |
2,809 |
$1.60M |
| D1120 |
Prophylaxis - child |
14,849 |
14,839 |
$586K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,962 |
2,544 |
$508K |
| D0120 |
Periodic oral evaluation - established patient |
13,216 |
13,205 |
$412K |
| D1206 |
Topical application of fluoride varnish |
15,633 |
15,622 |
$409K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,325 |
2,111 |
$385K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,659 |
1,253 |
$332K |
| D9420 |
|
1,655 |
1,643 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,995 |
1,502 |
$179K |
| D1510 |
|
910 |
606 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,199 |
4,752 |
$154K |
| D2332 |
|
1,255 |
693 |
$152K |
| D0272 |
Bitewings - two radiographic images |
6,497 |
6,490 |
$144K |
| D1351 |
Sealant - per tooth |
4,574 |
1,561 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
7,934 |
7,815 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
1,638 |
1,592 |
$91K |
| D1110 |
Prophylaxis - adult |
1,726 |
1,723 |
$82K |
| D9310 |
|
1,163 |
1,163 |
$80K |
| D1354 |
|
2,809 |
1,290 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,152 |
1,152 |
$63K |
| D2330 |
|
800 |
504 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
644 |
643 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
548 |
224 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,272 |
1,271 |
$48K |
| D0330 |
Panoramic radiographic image |
667 |
666 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,056 |
1,055 |
$36K |
| D2331 |
|
53 |
28 |
$5K |
| D2140 |
|
45 |
26 |
$3K |
| D2160 |
|
21 |
12 |
$2K |
| D9920 |
|
39 |
39 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,522 |
3,417 |
$0.00 |