| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3240 |
|
3,177 |
1,431 |
$1.04M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,594 |
1,353 |
$430K |
| D3230 |
|
1,603 |
802 |
$348K |
| D2335 |
|
1,777 |
871 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,195 |
1,315 |
$228K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,010 |
820 |
$138K |
| D2933 |
|
913 |
424 |
$126K |
| D9420 |
|
1,747 |
1,747 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,401 |
748 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,753 |
1,753 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,035 |
2,035 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,482 |
1,482 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
628 |
329 |
$30K |
| D1120 |
Prophylaxis - child |
1,392 |
1,392 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,684 |
1,683 |
$18K |
| D2332 |
|
19 |
17 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
182 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
1,188 |
1,188 |
$2K |
| D1510 |
|
13 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$294.50 |