| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,890 |
1,511 |
$876K |
| D1120 |
Prophylaxis - child |
19,375 |
19,057 |
$601K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,425 |
19,103 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
12,729 |
12,524 |
$281K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,025 |
1,716 |
$251K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,328 |
6,218 |
$218K |
| D0272 |
Bitewings - two radiographic images |
8,894 |
8,744 |
$178K |
| D1351 |
Sealant - per tooth |
6,707 |
1,902 |
$154K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,235 |
1,370 |
$153K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,784 |
687 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
4,269 |
4,009 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,077 |
1,348 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,062 |
3,828 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,401 |
1,351 |
$81K |
| D9420 |
|
935 |
904 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,107 |
2,071 |
$61K |
| D0240 |
|
2,503 |
1,603 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,572 |
2,522 |
$28K |
| D2934 |
|
127 |
42 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,381 |
1,139 |
$14K |
| D1110 |
Prophylaxis - adult |
370 |
365 |
$13K |
| D2929 |
|
103 |
26 |
$11K |
| D2331 |
|
63 |
42 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
41 |
$4K |
| D1510 |
|
19 |
12 |
$2K |
| D2330 |
|
30 |
15 |
$2K |
| D2332 |
|
17 |
13 |
$2K |
| D9920 |
|
14 |
13 |
$1K |
| D1999 |
|
47 |
44 |
$0.00 |