| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,706 |
2,899 |
$1.25M |
| D1120 |
Prophylaxis - child |
12,695 |
11,858 |
$370K |
| D0120 |
Periodic oral evaluation - established patient |
12,584 |
11,745 |
$259K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,198 |
4,829 |
$259K |
| D7111 |
|
4,227 |
1,866 |
$240K |
| D1206 |
Topical application of fluoride varnish |
13,811 |
12,902 |
$234K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,616 |
956 |
$120K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,652 |
940 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,059 |
3,757 |
$113K |
| D9420 |
|
884 |
771 |
$111K |
| D0272 |
Bitewings - two radiographic images |
5,756 |
5,298 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,713 |
1,580 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,490 |
947 |
$90K |
| D1110 |
Prophylaxis - adult |
2,128 |
1,973 |
$73K |
| D0240 |
|
2,273 |
1,708 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,145 |
1,049 |
$28K |
| D2330 |
|
522 |
284 |
$28K |
| D2940 |
|
532 |
238 |
$18K |
| D0274 |
Bitewings - four radiographic images |
783 |
718 |
$18K |
| D1510 |
|
137 |
95 |
$15K |
| D0330 |
Panoramic radiographic image |
286 |
265 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,053 |
794 |
$9K |
| D1354 |
|
981 |
296 |
$8K |
| D2331 |
|
86 |
50 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D1999 |
|
367 |
309 |
$0.00 |