| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,534 |
1,497 |
$1.02M |
| D0120 |
Periodic oral evaluation - established patient |
23,609 |
23,217 |
$603K |
| D1120 |
Prophylaxis - child |
14,302 |
14,047 |
$496K |
| D1110 |
Prophylaxis - adult |
9,176 |
9,047 |
$426K |
| D0272 |
Bitewings - two radiographic images |
18,889 |
18,592 |
$408K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,874 |
18,685 |
$370K |
| D0220 |
Intraoral - periapical first radiographic image |
19,960 |
19,522 |
$344K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,119 |
2,279 |
$268K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,570 |
18,172 |
$253K |
| D0210 |
Intraoral - complete series of radiographic images |
2,422 |
2,331 |
$185K |
| D1351 |
Sealant - per tooth |
6,937 |
2,259 |
$180K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,915 |
6,579 |
$173K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,124 |
1,470 |
$165K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,494 |
633 |
$125K |
| D2140 |
|
2,019 |
1,417 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,592 |
1,131 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,488 |
1,036 |
$89K |
| D0603 |
|
22,502 |
22,120 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,460 |
4,256 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
1,905 |
1,845 |
$60K |
| D0330 |
Panoramic radiographic image |
1,451 |
1,443 |
$20K |
| D2330 |
|
128 |
85 |
$9K |
| D0602 |
|
501 |
474 |
$2K |
| D0601 |
|
289 |
277 |
$1K |
| D7111 |
|
17 |
12 |
$807.50 |