| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,022 |
2,984 |
$1.34M |
| D1120 |
Prophylaxis - child |
39,626 |
37,953 |
$1.32M |
| D0120 |
Periodic oral evaluation - established patient |
44,878 |
43,662 |
$1.23M |
| D1208 |
Topical application of fluoride, excluding varnish |
49,878 |
48,511 |
$992K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,177 |
5,197 |
$854K |
| D1110 |
Prophylaxis - adult |
12,301 |
11,978 |
$604K |
| D1351 |
Sealant - per tooth |
20,937 |
6,439 |
$591K |
| D0272 |
Bitewings - two radiographic images |
31,045 |
29,871 |
$582K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,928 |
2,234 |
$335K |
| D9248 |
|
3,719 |
2,800 |
$322K |
| D0330 |
Panoramic radiographic image |
5,393 |
5,267 |
$312K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,193 |
5,916 |
$286K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,056 |
7,451 |
$283K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,565 |
2,344 |
$236K |
| D0220 |
Intraoral - periapical first radiographic image |
18,028 |
16,741 |
$235K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,407 |
4,223 |
$206K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,112 |
1,096 |
$186K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,789 |
7,923 |
$126K |
| D9420 |
|
1,322 |
1,205 |
$119K |
| D2390 |
|
510 |
201 |
$104K |
| D1206 |
Topical application of fluoride varnish |
5,151 |
4,686 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
489 |
377 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
2,215 |
2,091 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
485 |
481 |
$27K |
| D2330 |
|
59 |
38 |
$4K |
| D0270 |
|
282 |
280 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
38 |
36 |
$0.00 |