| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,968 |
1,956 |
$1.44M |
| D1120 |
Prophylaxis - child |
34,127 |
32,728 |
$922K |
| D0120 |
Periodic oral evaluation - established patient |
35,819 |
34,331 |
$919K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,739 |
3,375 |
$864K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,033 |
1,643 |
$655K |
| D1206 |
Topical application of fluoride varnish |
39,453 |
37,890 |
$629K |
| D1351 |
Sealant - per tooth |
12,869 |
3,073 |
$346K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,397 |
2,215 |
$283K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,594 |
1,705 |
$275K |
| D0272 |
Bitewings - two radiographic images |
14,634 |
13,995 |
$264K |
| D9420 |
|
1,743 |
1,660 |
$206K |
| D0330 |
Panoramic radiographic image |
3,237 |
3,127 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,417 |
2,375 |
$108K |
| D1110 |
Prophylaxis - adult |
2,589 |
2,491 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
2,049 |
1,940 |
$76K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,389 |
1,356 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
478 |
312 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,010 |
1,926 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
183 |
134 |
$24K |
| D2934 |
|
132 |
37 |
$23K |
| D2932 |
|
80 |
27 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,067 |
729 |
$13K |
| D2140 |
|
81 |
45 |
$6K |
| D1354 |
|
281 |
181 |
$2K |
| D2330 |
|
19 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
17 |
$694.45 |