| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,100 |
1,306 |
$1.24M |
| D1120 |
Prophylaxis - child |
17,492 |
17,492 |
$1.18M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,076 |
2,171 |
$709K |
| D1206 |
Topical application of fluoride varnish |
13,723 |
13,716 |
$656K |
| D0120 |
Periodic oral evaluation - established patient |
13,699 |
13,699 |
$634K |
| D1351 |
Sealant - per tooth |
4,316 |
2,068 |
$514K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,916 |
1,041 |
$282K |
| D1110 |
Prophylaxis - adult |
2,657 |
2,657 |
$242K |
| D0272 |
Bitewings - two radiographic images |
7,287 |
7,287 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,109 |
7,109 |
$177K |
| D0330 |
Panoramic radiographic image |
2,824 |
2,824 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,536 |
3,536 |
$176K |
| D9420 |
|
932 |
931 |
$138K |
| D0274 |
Bitewings - four radiographic images |
2,735 |
2,735 |
$127K |
| D9310 |
|
904 |
904 |
$117K |
| D2335 |
|
137 |
124 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
4,851 |
4,845 |
$111K |
| D0240 |
|
2,353 |
2,176 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,529 |
3,503 |
$100K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,880 |
1,880 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
383 |
342 |
$86K |
| D1354 |
|
1,904 |
523 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
2,440 |
2,433 |
$46K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
139 |
110 |
$46K |
| D0160 |
|
716 |
716 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,936 |
1,788 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
791 |
787 |
$23K |
| D9996 |
|
1,527 |
1,526 |
$18K |
| D0350 |
|
814 |
813 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
86 |
$17K |
| D9430 |
|
317 |
315 |
$10K |
| D9995 |
|
298 |
295 |
$6K |
| D9248 |
|
66 |
66 |
$0.00 |