| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,830 |
2,211 |
$1.27M |
| D1120 |
Prophylaxis - child |
19,726 |
19,211 |
$770K |
| D1351 |
Sealant - per tooth |
18,593 |
4,174 |
$553K |
| D0120 |
Periodic oral evaluation - established patient |
18,043 |
17,632 |
$536K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,899 |
16,386 |
$437K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,755 |
1,518 |
$302K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,517 |
1,349 |
$269K |
| D0272 |
Bitewings - two radiographic images |
8,853 |
8,540 |
$254K |
| D0240 |
|
5,713 |
4,021 |
$163K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,980 |
4,547 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,395 |
927 |
$124K |
| D9420 |
|
665 |
603 |
$115K |
| D1206 |
Topical application of fluoride varnish |
3,860 |
3,818 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,298 |
2,186 |
$103K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,046 |
460 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
1,569 |
1,396 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
2,735 |
2,586 |
$53K |
| D0330 |
Panoramic radiographic image |
583 |
578 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,091 |
1,062 |
$41K |
| D1353 |
|
713 |
335 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,796 |
725 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
651 |
623 |
$26K |
| D2932 |
|
49 |
14 |
$15K |