| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,942 |
3,418 |
$1.95M |
| D1120 |
Prophylaxis - child |
30,919 |
28,746 |
$809K |
| D0120 |
Periodic oral evaluation - established patient |
25,339 |
23,581 |
$632K |
| D1351 |
Sealant - per tooth |
18,676 |
3,632 |
$498K |
| D1206 |
Topical application of fluoride varnish |
31,584 |
29,385 |
$490K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,547 |
6,034 |
$278K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,196 |
1,442 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,492 |
4,176 |
$191K |
| D0272 |
Bitewings - two radiographic images |
9,269 |
8,604 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,493 |
920 |
$154K |
| D9420 |
|
1,302 |
1,212 |
$149K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,780 |
871 |
$138K |
| D2933 |
|
694 |
190 |
$132K |
| D0330 |
Panoramic radiographic image |
1,725 |
1,592 |
$94K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,566 |
2,376 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,645 |
1,814 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,724 |
1,585 |
$61K |
| D1354 |
|
10,002 |
3,293 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,408 |
3,149 |
$48K |
| D0240 |
|
3,039 |
2,797 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
356 |
275 |
$28K |
| D1110 |
Prophylaxis - adult |
606 |
583 |
$23K |
| D0274 |
Bitewings - four radiographic images |
52 |
50 |
$1K |
| D1330 |
|
247 |
246 |
$0.00 |