| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,088 |
2,121 |
$890K |
| D1120 |
Prophylaxis - child |
13,304 |
12,741 |
$407K |
| D1206 |
Topical application of fluoride varnish |
15,564 |
14,950 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
14,160 |
13,633 |
$281K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,892 |
1,227 |
$266K |
| D1351 |
Sealant - per tooth |
10,760 |
2,355 |
$265K |
| D1110 |
Prophylaxis - adult |
2,895 |
2,819 |
$120K |
| D0330 |
Panoramic radiographic image |
1,814 |
1,744 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,921 |
2,813 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,902 |
4,788 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,082 |
2,784 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,376 |
3,227 |
$75K |
| D0240 |
|
5,024 |
2,491 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,836 |
1,725 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,117 |
649 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,699 |
1,573 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,877 |
4,609 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
924 |
584 |
$42K |
| D2330 |
|
298 |
147 |
$18K |
| D9920 |
|
479 |
414 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
2,015 |
1,375 |
$17K |
| D2332 |
|
101 |
58 |
$9K |
| D0160 |
|
141 |
119 |
$7K |
| D1510 |
|
32 |
25 |
$6K |
| D0170 |
|
183 |
175 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
51 |
$2K |
| D1352 |
|
132 |
44 |
$2K |
| D1354 |
|
38 |
12 |
$1K |
| D9971 |
|
359 |
106 |
$0.00 |
| D9420 |
|
855 |
813 |
$0.00 |