| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,072 |
2,091 |
$1.19M |
| D1120 |
Prophylaxis - child |
13,049 |
11,879 |
$340K |
| D1351 |
Sealant - per tooth |
13,450 |
2,313 |
$296K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,561 |
15,035 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
14,363 |
12,986 |
$254K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,056 |
1,773 |
$233K |
| D0272 |
Bitewings - two radiographic images |
9,832 |
8,895 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
3,168 |
2,450 |
$154K |
| D1110 |
Prophylaxis - adult |
3,638 |
3,267 |
$142K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,872 |
712 |
$126K |
| D0240 |
|
10,325 |
4,380 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,596 |
2,396 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,975 |
1,773 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,299 |
2,070 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,057 |
619 |
$49K |
| D2140 |
|
1,224 |
640 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,351 |
3,943 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,476 |
2,946 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
142 |
$13K |
| D1516 |
|
35 |
29 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
198 |
131 |
$4K |
| D9248 |
|
217 |
205 |
$3K |
| D9920 |
|
141 |
127 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$645.20 |
| D2330 |
|
46 |
26 |
$79.18 |
| D1330 |
|
1,021 |
940 |
$0.00 |