| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,876 |
6,563 |
$2.06M |
| D1120 |
Prophylaxis - child |
48,335 |
46,744 |
$1.27M |
| D0120 |
Periodic oral evaluation - established patient |
42,765 |
41,632 |
$876K |
| D1206 |
Topical application of fluoride varnish |
54,348 |
52,613 |
$851K |
| D1351 |
Sealant - per tooth |
32,331 |
6,983 |
$648K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,551 |
3,079 |
$431K |
| D0272 |
Bitewings - two radiographic images |
23,113 |
22,210 |
$385K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,322 |
3,798 |
$378K |
| D9248 |
|
2,449 |
2,301 |
$325K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,081 |
2,424 |
$279K |
| D0220 |
Intraoral - periapical first radiographic image |
22,705 |
21,653 |
$248K |
| D1110 |
Prophylaxis - adult |
6,138 |
5,975 |
$228K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,269 |
2,652 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,389 |
7,754 |
$187K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,154 |
8,624 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,593 |
15,295 |
$156K |
| D0330 |
Panoramic radiographic image |
3,412 |
3,345 |
$155K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,443 |
5,292 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
3,477 |
3,323 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,195 |
3,084 |
$82K |
| D9420 |
|
1,336 |
1,268 |
$51K |
| D2934 |
|
264 |
80 |
$30K |
| D1354 |
|
806 |
259 |
$3K |
| D2330 |
|
54 |
32 |
$3K |
| D2335 |
|
15 |
12 |
$1K |
| D7111 |
|
18 |
13 |
$773.38 |
| D0240 |
|
38 |
27 |
$491.08 |
| D1999 |
|
25,020 |
22,902 |
$0.00 |