| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,606 |
2,648 |
$1.84M |
| D1120 |
Prophylaxis - child |
19,914 |
19,913 |
$677K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,975 |
2,248 |
$564K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,754 |
2,345 |
$551K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,917 |
25,916 |
$414K |
| D1351 |
Sealant - per tooth |
11,868 |
3,560 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
15,048 |
15,047 |
$339K |
| D0272 |
Bitewings - two radiographic images |
17,049 |
17,049 |
$311K |
| D9420 |
|
3,341 |
3,341 |
$293K |
| D1110 |
Prophylaxis - adult |
6,005 |
6,005 |
$288K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,132 |
1,622 |
$257K |
| D0220 |
Intraoral - periapical first radiographic image |
18,221 |
18,112 |
$231K |
| D0330 |
Panoramic radiographic image |
4,674 |
4,674 |
$230K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,154 |
16,843 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,514 |
3,514 |
$142K |
| D7111 |
|
1,644 |
848 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,012 |
564 |
$104K |
| D9248 |
|
1,186 |
1,180 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,760 |
1,760 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,369 |
2,352 |
$74K |
| D9920 |
|
865 |
864 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
916 |
915 |
$34K |
| D0240 |
|
2,117 |
1,147 |
$12K |
| D2932 |
|
77 |
26 |
$11K |
| D2330 |
|
74 |
52 |
$6K |