| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,243 |
2,180 |
$1.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,468 |
2,017 |
$370K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,007 |
2,246 |
$358K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,416 |
3,784 |
$190K |
| D0272 |
Bitewings - two radiographic images |
7,086 |
5,266 |
$179K |
| D1120 |
Prophylaxis - child |
3,500 |
3,219 |
$151K |
| D0330 |
Panoramic radiographic image |
1,801 |
1,428 |
$147K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,681 |
1,448 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
4,318 |
3,286 |
$140K |
| D0240 |
|
4,997 |
2,402 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,384 |
1,008 |
$110K |
| D0470 |
|
1,471 |
1,186 |
$103K |
| D1206 |
Topical application of fluoride varnish |
3,706 |
3,429 |
$96K |
| D1510 |
|
259 |
208 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
440 |
349 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
650 |
591 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,022 |
875 |
$15K |
| D1354 |
|
935 |
222 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
511 |
465 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
93 |
74 |
$10K |
| D1110 |
Prophylaxis - adult |
173 |
162 |
$6K |
| D1515 |
|
18 |
12 |
$4K |
| D0274 |
Bitewings - four radiographic images |
138 |
121 |
$3K |
| D2330 |
|
17 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
75 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
146 |
103 |
$1K |
| D9420 |
|
12 |
12 |
$1K |
| D9910 |
|
746 |
37 |
$398.05 |