| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,115 |
3,703 |
$1.04M |
| D9248 |
|
8,681 |
8,677 |
$598K |
| D1120 |
Prophylaxis - child |
16,223 |
16,223 |
$566K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,578 |
4,277 |
$533K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,708 |
2,503 |
$382K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,524 |
2,568 |
$373K |
| D0120 |
Periodic oral evaluation - established patient |
15,149 |
15,149 |
$354K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,444 |
1,918 |
$330K |
| D0272 |
Bitewings - two radiographic images |
16,915 |
16,915 |
$321K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,966 |
8,961 |
$289K |
| D1110 |
Prophylaxis - adult |
5,060 |
5,060 |
$254K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,882 |
5,882 |
$241K |
| D0330 |
Panoramic radiographic image |
4,107 |
4,106 |
$205K |
| D1206 |
Topical application of fluoride varnish |
10,783 |
10,783 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,722 |
10,722 |
$175K |
| D1351 |
Sealant - per tooth |
5,260 |
1,976 |
$156K |
| D0140 |
Limited oral evaluation - problem focused |
2,542 |
2,541 |
$98K |
| D2330 |
|
1,273 |
791 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
5,053 |
5,030 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,966 |
1,966 |
$55K |
| D1354 |
|
4,752 |
1,333 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,574 |
1,606 |
$26K |
| D7111 |
|
195 |
146 |
$13K |
| D9310 |
|
177 |
177 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
63 |
63 |
$3K |
| D2940 |
|
48 |
39 |
$2K |
| D2331 |
|
16 |
12 |
$1K |