| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,487 |
2,775 |
$1.21M |
| D1120 |
Prophylaxis - child |
19,013 |
17,621 |
$528K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,715 |
4,258 |
$440K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,203 |
2,709 |
$427K |
| D1206 |
Topical application of fluoride varnish |
22,283 |
20,616 |
$402K |
| D0120 |
Periodic oral evaluation - established patient |
18,522 |
17,160 |
$358K |
| D1351 |
Sealant - per tooth |
11,311 |
2,362 |
$262K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,732 |
1,499 |
$227K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,822 |
7,223 |
$225K |
| D0274 |
Bitewings - four radiographic images |
7,530 |
6,930 |
$203K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,872 |
2,632 |
$164K |
| D1110 |
Prophylaxis - adult |
3,483 |
3,226 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,079 |
3,825 |
$122K |
| D0140 |
Limited oral evaluation - problem focused |
3,436 |
3,126 |
$106K |
| D1510 |
|
753 |
419 |
$88K |
| D2331 |
|
1,007 |
506 |
$81K |
| D0330 |
Panoramic radiographic image |
1,619 |
1,475 |
$73K |
| D1354 |
|
911 |
325 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
3,057 |
1,521 |
$50K |
| D2330 |
|
585 |
343 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,376 |
1,857 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
403 |
274 |
$28K |
| D0240 |
|
2,124 |
1,280 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,889 |
2,172 |
$20K |
| D2332 |
|
220 |
136 |
$14K |
| D2335 |
|
106 |
62 |
$10K |
| D9420 |
|
1,465 |
1,339 |
$0.00 |