| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,372 |
5,178 |
$1.05M |
| D1120 |
Prophylaxis - child |
25,418 |
25,242 |
$861K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,589 |
5,440 |
$631K |
| D1206 |
Topical application of fluoride varnish |
26,224 |
26,039 |
$558K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,761 |
4,991 |
$466K |
| D0120 |
Periodic oral evaluation - established patient |
15,848 |
15,738 |
$386K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,307 |
11,684 |
$356K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,961 |
9,878 |
$290K |
| D0330 |
Panoramic radiographic image |
5,821 |
5,762 |
$241K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,722 |
2,462 |
$213K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,867 |
8,005 |
$210K |
| D1351 |
Sealant - per tooth |
6,132 |
2,469 |
$190K |
| D0272 |
Bitewings - two radiographic images |
7,978 |
7,918 |
$139K |
| D0220 |
Intraoral - periapical first radiographic image |
11,756 |
11,583 |
$137K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,521 |
1,136 |
$123K |
| D1110 |
Prophylaxis - adult |
1,894 |
1,867 |
$77K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,747 |
1,741 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,159 |
1,143 |
$30K |
| D1354 |
|
3,665 |
1,108 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,028 |
1,010 |
$23K |
| D2332 |
|
265 |
229 |
$22K |
| D2390 |
|
99 |
50 |
$16K |
| D2330 |
|
132 |
105 |
$8K |
| D1510 |
|
44 |
38 |
$7K |
| D2331 |
|
16 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |