| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,854 |
5,066 |
$1.89M |
| D1120 |
Prophylaxis - child |
21,034 |
20,837 |
$586K |
| D1351 |
Sealant - per tooth |
16,101 |
4,465 |
$450K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,709 |
3,153 |
$436K |
| D0120 |
Periodic oral evaluation - established patient |
15,873 |
15,742 |
$416K |
| D1206 |
Topical application of fluoride varnish |
21,249 |
20,997 |
$347K |
| D2934 |
|
1,762 |
559 |
$342K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,037 |
6,951 |
$310K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,591 |
2,054 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,641 |
2,050 |
$279K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,326 |
1,459 |
$194K |
| D0272 |
Bitewings - two radiographic images |
10,112 |
10,002 |
$187K |
| D3230 |
|
1,273 |
376 |
$186K |
| D0330 |
Panoramic radiographic image |
2,683 |
2,659 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,200 |
3,155 |
$144K |
| D9420 |
|
1,163 |
1,136 |
$139K |
| D0240 |
|
6,273 |
3,263 |
$103K |
| D2330 |
|
1,394 |
829 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
5,757 |
5,681 |
$88K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,972 |
1,955 |
$73K |
| D9110 |
|
1,401 |
1,384 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,469 |
1,448 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,202 |
4,132 |
$52K |
| D2940 |
|
896 |
566 |
$36K |
| D1510 |
|
89 |
81 |
$17K |
| D2331 |
|
17 |
13 |
$1K |