| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
18,086 |
3,958 |
$1.35M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,145 |
1,106 |
$514K |
| D1120 |
Prophylaxis - child |
12,682 |
12,044 |
$366K |
| D1206 |
Topical application of fluoride varnish |
12,040 |
11,485 |
$256K |
| D0120 |
Periodic oral evaluation - established patient |
13,343 |
12,691 |
$255K |
| D0272 |
Bitewings - two radiographic images |
11,301 |
10,719 |
$233K |
| D1351 |
Sealant - per tooth |
7,599 |
1,268 |
$166K |
| D1110 |
Prophylaxis - adult |
2,645 |
2,509 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,198 |
627 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,040 |
2,574 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
2,043 |
1,836 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,818 |
1,716 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,405 |
1,309 |
$36K |
| D0240 |
|
2,470 |
1,271 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
630 |
339 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,801 |
2,608 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,638 |
1,544 |
$15K |
| D2140 |
|
410 |
229 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
108 |
60 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
885 |
519 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
67 |
$5K |
| D2920 |
|
59 |
51 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
16 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$193.56 |
| D9920 |
|
14 |
14 |
$46.75 |
| D1999 |
|
170 |
134 |
$30.24 |
| D1355 |
|
179 |
52 |
$0.00 |