| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,009 |
3,995 |
$2.16M |
| D1120 |
Prophylaxis - child |
34,240 |
33,899 |
$1.74M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,506 |
5,789 |
$974K |
| D1206 |
Topical application of fluoride varnish |
36,114 |
35,745 |
$945K |
| D0120 |
Periodic oral evaluation - established patient |
31,084 |
30,773 |
$896K |
| D0272 |
Bitewings - two radiographic images |
23,780 |
23,534 |
$708K |
| D1351 |
Sealant - per tooth |
15,549 |
5,499 |
$628K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,137 |
3,982 |
$567K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,684 |
1,853 |
$477K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,579 |
3,008 |
$466K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,213 |
5,162 |
$311K |
| D0140 |
Limited oral evaluation - problem focused |
6,245 |
6,144 |
$278K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,145 |
11,802 |
$253K |
| D1110 |
Prophylaxis - adult |
3,604 |
3,561 |
$246K |
| D0220 |
Intraoral - periapical first radiographic image |
9,270 |
9,101 |
$183K |
| D0330 |
Panoramic radiographic image |
1,770 |
1,756 |
$119K |
| D1354 |
|
5,294 |
1,428 |
$73K |
| D2330 |
|
661 |
295 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,682 |
1,565 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
324 |
289 |
$41K |
| D7111 |
|
453 |
315 |
$34K |
| D1510 |
|
111 |
84 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
772 |
763 |
$20K |
| D3120 |
|
433 |
349 |
$17K |
| D2929 |
|
76 |
24 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
295 |
295 |
$9K |
| D7962 |
|
15 |
15 |
$5K |
| D2390 |
|
29 |
12 |
$4K |
| D2331 |
|
27 |
14 |
$3K |
| D0270 |
|
59 |
57 |
$935.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$598.00 |
| D9410 |
|
715 |
694 |
$0.00 |