| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,849 |
3,780 |
$1.52M |
| D1120 |
Prophylaxis - child |
34,615 |
34,432 |
$1.15M |
| D1206 |
Topical application of fluoride varnish |
36,816 |
36,639 |
$759K |
| D0120 |
Periodic oral evaluation - established patient |
26,667 |
26,542 |
$645K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,510 |
2,908 |
$468K |
| D1351 |
Sealant - per tooth |
10,913 |
3,212 |
$335K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,269 |
10,211 |
$296K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,151 |
1,747 |
$255K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,028 |
2,278 |
$244K |
| D0272 |
Bitewings - two radiographic images |
14,047 |
13,959 |
$210K |
| D0330 |
Panoramic radiographic image |
4,141 |
4,122 |
$175K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,876 |
5,613 |
$170K |
| D2929 |
|
1,472 |
529 |
$167K |
| D2390 |
|
1,034 |
410 |
$162K |
| D0220 |
Intraoral - periapical first radiographic image |
11,888 |
11,771 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,010 |
1,194 |
$142K |
| D1510 |
|
907 |
614 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
1,965 |
1,954 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,235 |
9,873 |
$104K |
| D1110 |
Prophylaxis - adult |
2,370 |
2,363 |
$100K |
| D2330 |
|
1,638 |
920 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
3,357 |
3,323 |
$76K |
| D1354 |
|
9,157 |
2,362 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,904 |
1,895 |
$44K |
| D2331 |
|
279 |
162 |
$19K |
| D2931 |
|
19 |
12 |
$2K |
| D3230 |
|
22 |
13 |
$2K |
| D1353 |
|
48 |
14 |
$1K |
| D9420 |
|
2,284 |
2,264 |
$955.00 |
| D0270 |
|
26 |
26 |
$189.12 |
| D0251 |
|
55 |
55 |
$0.00 |