| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,626 |
2,431 |
$1.15M |
| D1120 |
Prophylaxis - child |
13,855 |
13,834 |
$579K |
| D0120 |
Periodic oral evaluation - established patient |
12,904 |
12,890 |
$554K |
| D1206 |
Topical application of fluoride varnish |
15,779 |
15,752 |
$488K |
| D7111 |
|
2,524 |
1,390 |
$293K |
| D1351 |
Sealant - per tooth |
7,654 |
2,089 |
$291K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,430 |
1,437 |
$251K |
| D0272 |
Bitewings - two radiographic images |
6,114 |
6,105 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,982 |
2,977 |
$163K |
| D1110 |
Prophylaxis - adult |
2,429 |
2,427 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,768 |
1,104 |
$136K |
| D0330 |
Panoramic radiographic image |
1,249 |
1,246 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
2,220 |
2,184 |
$120K |
| D0240 |
|
2,898 |
1,586 |
$107K |
| D2330 |
|
1,294 |
578 |
$103K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,151 |
679 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,862 |
3,759 |
$82K |
| D2331 |
|
589 |
310 |
$66K |
| D1330 |
|
1,700 |
1,700 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
592 |
381 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
591 |
333 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
1,959 |
1,945 |
$46K |
| D2390 |
|
258 |
93 |
$43K |
| D0274 |
Bitewings - four radiographic images |
725 |
725 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
269 |
$31K |
| D1510 |
|
114 |
90 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,106 |
654 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
286 |
284 |
$15K |
| D9420 |
|
440 |
379 |
$12K |
| D2140 |
|
115 |
81 |
$7K |
| D1354 |
|
92 |
24 |
$3K |