| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,805 |
3,329 |
$2.08M |
| D1120 |
Prophylaxis - child |
64,780 |
56,446 |
$1.74M |
| D0120 |
Periodic oral evaluation - established patient |
51,412 |
48,987 |
$1.40M |
| D1206 |
Topical application of fluoride varnish |
51,811 |
44,600 |
$1.14M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,304 |
7,003 |
$1.13M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,483 |
17,378 |
$489K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,750 |
13,461 |
$484K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,954 |
4,163 |
$450K |
| D0272 |
Bitewings - two radiographic images |
23,343 |
19,912 |
$410K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,585 |
2,666 |
$391K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,216 |
1,468 |
$347K |
| D1351 |
Sealant - per tooth |
11,594 |
2,741 |
$316K |
| D0140 |
Limited oral evaluation - problem focused |
4,139 |
3,845 |
$168K |
| D0330 |
Panoramic radiographic image |
3,669 |
3,189 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,761 |
8,079 |
$146K |
| D0274 |
Bitewings - four radiographic images |
4,549 |
4,314 |
$136K |
| D9248 |
|
2,829 |
2,590 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
4,559 |
4,006 |
$54K |
| D9420 |
|
149 |
140 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
591 |
345 |
$22K |
| D1110 |
Prophylaxis - adult |
465 |
436 |
$21K |
| D2330 |
|
89 |
52 |
$6K |
| D2934 |
|
37 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D0240 |
|
735 |
566 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$11.34 |