| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,867 |
2,375 |
$1.27M |
| D1120 |
Prophylaxis - child |
16,193 |
15,847 |
$504K |
| D0120 |
Periodic oral evaluation - established patient |
17,738 |
17,381 |
$426K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,482 |
1,930 |
$350K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,510 |
2,481 |
$343K |
| D1206 |
Topical application of fluoride varnish |
18,620 |
18,196 |
$269K |
| D0240 |
|
17,136 |
10,326 |
$257K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,785 |
2,159 |
$255K |
| D1351 |
Sealant - per tooth |
7,803 |
2,375 |
$196K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,268 |
1,463 |
$184K |
| D0272 |
Bitewings - two radiographic images |
7,942 |
7,729 |
$158K |
| D9248 |
|
1,296 |
1,206 |
$154K |
| D1110 |
Prophylaxis - adult |
2,929 |
2,864 |
$145K |
| D2934 |
|
850 |
248 |
$117K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,367 |
614 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,618 |
3,332 |
$95K |
| D0330 |
Panoramic radiographic image |
1,674 |
1,635 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
5,451 |
5,166 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,024 |
3,032 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
2,175 |
2,118 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,640 |
1,571 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,582 |
1,555 |
$50K |
| D2330 |
|
387 |
271 |
$25K |
| D9420 |
|
550 |
539 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
823 |
821 |
$11K |
| D1510 |
|
76 |
51 |
$9K |
| D2331 |
|
67 |
50 |
$6K |
| D2332 |
|
18 |
15 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
43 |
$2K |
| D0603 |
|
15,250 |
14,866 |
$1K |
| D3120 |
|
24 |
12 |
$152.45 |
| D1999 |
|
183 |
177 |
$0.00 |