| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
20,299 |
2,618 |
$1.17M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,554 |
484 |
$198K |
| D2941 |
|
1,535 |
500 |
$143K |
| D1120 |
Prophylaxis - child |
3,857 |
3,424 |
$127K |
| D1206 |
Topical application of fluoride varnish |
4,523 |
4,007 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,053 |
1,801 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
724 |
255 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
696 |
268 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,213 |
2,017 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,495 |
1,251 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,574 |
1,476 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
513 |
179 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,068 |
1,822 |
$22K |
| D1351 |
Sealant - per tooth |
698 |
151 |
$21K |
| D1110 |
Prophylaxis - adult |
352 |
320 |
$16K |
| D0330 |
Panoramic radiographic image |
337 |
299 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,533 |
813 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
300 |
250 |
$14K |
| D2940 |
|
287 |
111 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
391 |
353 |
$13K |
| D2390 |
|
109 |
42 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
131 |
59 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
267 |
252 |
$9K |
| D7962 |
|
24 |
24 |
$7K |
| D7111 |
|
69 |
40 |
$6K |
| D9920 |
|
129 |
104 |
$6K |
| D1320 |
|
152 |
138 |
$3K |
| D0274 |
Bitewings - four radiographic images |
90 |
84 |
$3K |
| D0170 |
|
15 |
14 |
$515.97 |
| D0240 |
|
18 |
17 |
$333.00 |
| D0350 |
|
372 |
278 |
$0.00 |
| D1321 |
|
142 |
128 |
$0.00 |
| D0171 |
|
64 |
64 |
$0.00 |
| D1310 |
|
297 |
223 |
$0.00 |
| D0603 |
|
4,575 |
4,096 |
$0.00 |
| D1330 |
|
401 |
291 |
$0.00 |
| D9420 |
|
90 |
79 |
$0.00 |