| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,586 |
3,684 |
$1.46M |
| D1120 |
Prophylaxis - child |
23,021 |
22,964 |
$966K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,816 |
4,824 |
$952K |
| D1206 |
Topical application of fluoride varnish |
23,171 |
23,114 |
$655K |
| D0120 |
Periodic oral evaluation - established patient |
18,695 |
18,637 |
$629K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,015 |
3,321 |
$522K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,637 |
3,349 |
$430K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,390 |
1,632 |
$304K |
| D0272 |
Bitewings - two radiographic images |
10,332 |
10,292 |
$248K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,849 |
3,844 |
$229K |
| D1351 |
Sealant - per tooth |
7,328 |
2,968 |
$226K |
| D0220 |
Intraoral - periapical first radiographic image |
7,361 |
7,212 |
$134K |
| D0330 |
Panoramic radiographic image |
1,402 |
1,397 |
$94K |
| D0240 |
|
4,402 |
2,354 |
$92K |
| D9310 |
|
1,289 |
1,282 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,081 |
1,081 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,462 |
3,619 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
1,414 |
1,406 |
$85K |
| D1354 |
|
3,153 |
1,058 |
$83K |
| D1510 |
|
376 |
298 |
$76K |
| D1110 |
Prophylaxis - adult |
992 |
989 |
$54K |
| D0274 |
Bitewings - four radiographic images |
841 |
838 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
745 |
744 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
199 |
173 |
$29K |
| D9110 |
|
302 |
301 |
$25K |
| D2332 |
|
183 |
129 |
$23K |
| D2390 |
|
112 |
52 |
$22K |
| D2330 |
|
140 |
89 |
$12K |
| D9920 |
|
50 |
48 |
$1K |
| D9248 |
|
14 |
12 |
$660.00 |
| D3120 |
|
17 |
12 |
$0.00 |