| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,734 |
6,069 |
$1.82M |
| D1120 |
Prophylaxis - child |
69,268 |
68,076 |
$1.44M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,258 |
11,364 |
$1.36M |
| D0120 |
Periodic oral evaluation - established patient |
57,369 |
56,508 |
$995K |
| D1351 |
Sealant - per tooth |
44,882 |
12,368 |
$936K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25,088 |
24,543 |
$745K |
| D1208 |
Topical application of fluoride, excluding varnish |
52,092 |
51,172 |
$650K |
| D1206 |
Topical application of fluoride varnish |
30,738 |
30,188 |
$622K |
| D0140 |
Limited oral evaluation - problem focused |
19,359 |
18,824 |
$429K |
| D0272 |
Bitewings - two radiographic images |
32,443 |
31,903 |
$342K |
| D2390 |
|
2,067 |
779 |
$314K |
| D1110 |
Prophylaxis - adult |
8,221 |
8,096 |
$290K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,670 |
4,023 |
$264K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,678 |
11,776 |
$238K |
| D0220 |
Intraoral - periapical first radiographic image |
24,408 |
23,475 |
$127K |
| D0330 |
Panoramic radiographic image |
2,164 |
2,128 |
$91K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,543 |
969 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,770 |
1,359 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,477 |
3,419 |
$79K |
| D1354 |
|
5,870 |
2,691 |
$76K |
| D2330 |
|
1,554 |
1,041 |
$62K |
| D2335 |
|
707 |
478 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,855 |
3,221 |
$39K |
| D2331 |
|
300 |
205 |
$15K |
| D8670 |
Periodic orthodontic treatment visit |
98 |
92 |
$8K |
| D3310 |
|
17 |
12 |
$8K |
| D0270 |
|
660 |
639 |
$3K |
| D0470 |
|
26 |
25 |
$550.50 |
| D0350 |
|
26 |
26 |
$295.44 |
| D0460 |
|
720 |
694 |
$0.00 |
| D8660 |
|
160 |
158 |
$0.00 |
| D2940 |
|
46 |
24 |
$0.00 |
| D0170 |
|
2,024 |
1,883 |
$0.00 |
| D9248 |
|
115 |
113 |
$0.00 |
| D7111 |
|
37 |
25 |
$0.00 |
| D9995 |
|
13 |
13 |
$0.00 |