| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,909 |
6,969 |
$2.81M |
| D7140 |
Extraction, erupted tooth or exposed root |
20,674 |
8,132 |
$1.37M |
| D1206 |
Topical application of fluoride varnish |
67,512 |
64,629 |
$1.35M |
| D1120 |
Prophylaxis - child |
54,999 |
52,708 |
$1.27M |
| D0120 |
Periodic oral evaluation - established patient |
56,709 |
54,463 |
$1.13M |
| D1351 |
Sealant - per tooth |
28,964 |
8,510 |
$632K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,164 |
5,471 |
$476K |
| D1110 |
Prophylaxis - adult |
11,597 |
11,175 |
$456K |
| D0272 |
Bitewings - two radiographic images |
33,982 |
32,540 |
$395K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,432 |
11,827 |
$368K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,613 |
4,038 |
$331K |
| D0140 |
Limited oral evaluation - problem focused |
10,800 |
10,206 |
$265K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,618 |
6,082 |
$243K |
| D0240 |
|
8,782 |
5,223 |
$105K |
| D8030 |
|
1,165 |
1,039 |
$96K |
| D1354 |
|
4,760 |
2,068 |
$86K |
| D0330 |
Panoramic radiographic image |
712 |
664 |
$55K |
| D2335 |
|
387 |
171 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,996 |
4,731 |
$29K |
| D0274 |
Bitewings - four radiographic images |
630 |
594 |
$16K |
| D2330 |
|
224 |
129 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
151 |
77 |
$12K |
| D8670 |
Periodic orthodontic treatment visit |
42 |
42 |
$11K |
| D0350 |
|
12 |
12 |
$264.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
13 |
$140.00 |
| D3120 |
|
78 |
52 |
$0.00 |