| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,225 |
1,535 |
$1.59M |
| D1120 |
Prophylaxis - child |
11,385 |
10,591 |
$644K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,981 |
1,121 |
$473K |
| D1351 |
Sealant - per tooth |
10,116 |
2,514 |
$437K |
| D0120 |
Periodic oral evaluation - established patient |
9,025 |
8,405 |
$382K |
| D1206 |
Topical application of fluoride varnish |
14,546 |
13,434 |
$368K |
| D0272 |
Bitewings - two radiographic images |
5,427 |
5,078 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,837 |
2,677 |
$171K |
| D0330 |
Panoramic radiographic image |
1,598 |
1,525 |
$146K |
| D0240 |
|
4,793 |
2,860 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,155 |
2,252 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
4,018 |
3,627 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
550 |
336 |
$63K |
| D3240 |
|
209 |
91 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
831 |
750 |
$47K |
| D0274 |
Bitewings - four radiographic images |
836 |
784 |
$45K |
| D1110 |
Prophylaxis - adult |
597 |
553 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
94 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
482 |
403 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
245 |
235 |
$13K |
| D2330 |
|
59 |
32 |
$6K |
| D2332 |
|
31 |
18 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
103 |
$3K |
| D9995 |
|
15 |
14 |
$0.00 |
| D3120 |
|
58 |
26 |
$0.00 |
| D1354 |
|
2,103 |
429 |
$0.00 |