| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,745 |
4,107 |
$1.87M |
| D1120 |
Prophylaxis - child |
17,507 |
17,299 |
$644K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,659 |
2,235 |
$538K |
| D2390 |
|
2,472 |
961 |
$502K |
| D0120 |
Periodic oral evaluation - established patient |
14,876 |
14,680 |
$424K |
| D9248 |
|
2,317 |
2,040 |
$272K |
| D0272 |
Bitewings - two radiographic images |
17,997 |
17,671 |
$259K |
| D7111 |
|
3,820 |
1,865 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,143 |
10,995 |
$232K |
| D1206 |
Topical application of fluoride varnish |
7,812 |
7,733 |
$200K |
| D1351 |
Sealant - per tooth |
6,402 |
1,757 |
$199K |
| D0220 |
Intraoral - periapical first radiographic image |
11,928 |
11,784 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,705 |
1,747 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,115 |
3,071 |
$154K |
| D0330 |
Panoramic radiographic image |
2,655 |
2,611 |
$145K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,747 |
2,731 |
$134K |
| D9420 |
|
1,477 |
1,369 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,046 |
703 |
$94K |
| D9920 |
|
1,490 |
1,301 |
$89K |
| D1110 |
Prophylaxis - adult |
1,503 |
1,473 |
$77K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,028 |
1,933 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,282 |
3,230 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,020 |
1,006 |
$15K |
| D2330 |
|
129 |
92 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
30 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$2K |
| D0350 |
|
8,717 |
4,888 |
$164.52 |