| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,071 |
1,814 |
$1.24M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,857 |
2,179 |
$1.02M |
| D7140 |
Extraction, erupted tooth or exposed root |
5,523 |
2,257 |
$697K |
| D1120 |
Prophylaxis - child |
11,277 |
11,078 |
$591K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,803 |
1,974 |
$567K |
| D0120 |
Periodic oral evaluation - established patient |
9,449 |
9,322 |
$389K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,265 |
962 |
$345K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,240 |
11,036 |
$285K |
| D1351 |
Sealant - per tooth |
5,342 |
1,552 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,596 |
2,512 |
$182K |
| D0272 |
Bitewings - two radiographic images |
5,522 |
5,365 |
$178K |
| D0140 |
Limited oral evaluation - problem focused |
2,661 |
2,500 |
$158K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,907 |
2,646 |
$150K |
| D0170 |
|
2,138 |
2,010 |
$115K |
| D9420 |
|
344 |
336 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
3,501 |
3,333 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,885 |
1,843 |
$68K |
| D2929 |
|
213 |
53 |
$65K |
| D0240 |
|
668 |
391 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
170 |
$18K |
| D2932 |
|
56 |
15 |
$16K |
| D0330 |
Panoramic radiographic image |
137 |
135 |
$11K |
| D1510 |
|
35 |
27 |
$8K |
| D2330 |
|
58 |
37 |
$7K |
| D2933 |
|
38 |
12 |
$7K |
| D1110 |
Prophylaxis - adult |
122 |
122 |
$6K |
| D0274 |
Bitewings - four radiographic images |
92 |
90 |
$5K |