| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,596 |
7,429 |
$4.03M |
| D1120 |
Prophylaxis - child |
66,671 |
64,623 |
$2.60M |
| D1206 |
Topical application of fluoride varnish |
73,682 |
71,400 |
$1.70M |
| D0120 |
Periodic oral evaluation - established patient |
42,193 |
40,814 |
$1.24M |
| D1351 |
Sealant - per tooth |
39,295 |
8,402 |
$1.17M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25,557 |
24,163 |
$1.14M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,461 |
6,056 |
$1.04M |
| D0160 |
|
12,251 |
11,919 |
$1.04M |
| D0272 |
Bitewings - two radiographic images |
32,661 |
31,687 |
$853K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,576 |
3,027 |
$580K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,442 |
4,454 |
$541K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,669 |
7,440 |
$372K |
| D0210 |
Intraoral - complete series of radiographic images |
3,886 |
3,776 |
$305K |
| D0191 |
|
7,802 |
7,668 |
$127K |
| D0240 |
|
5,801 |
3,170 |
$124K |
| D9420 |
|
581 |
539 |
$105K |
| D1110 |
Prophylaxis - adult |
1,964 |
1,921 |
$102K |
| D1354 |
|
9,030 |
2,802 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
723 |
361 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
862 |
823 |
$34K |
| D0274 |
Bitewings - four radiographic images |
472 |
460 |
$18K |
| D0330 |
Panoramic radiographic image |
232 |
230 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
685 |
646 |
$11K |
| D9910 |
|
134 |
60 |
$5K |
| D1310 |
|
4,836 |
4,685 |
$0.00 |
| D0603 |
|
4,801 |
4,652 |
$0.00 |