| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,287 |
2,244 |
$1.26M |
| D1120 |
Prophylaxis - child |
32,868 |
32,445 |
$1.11M |
| D0120 |
Periodic oral evaluation - established patient |
29,534 |
29,154 |
$714K |
| D1206 |
Topical application of fluoride varnish |
34,972 |
34,507 |
$681K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,164 |
2,244 |
$546K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,931 |
2,198 |
$400K |
| D0272 |
Bitewings - two radiographic images |
12,921 |
12,749 |
$272K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,266 |
10,056 |
$253K |
| D1351 |
Sealant - per tooth |
6,916 |
2,182 |
$232K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,238 |
1,184 |
$216K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,272 |
6,133 |
$195K |
| D0220 |
Intraoral - periapical first radiographic image |
14,371 |
14,022 |
$182K |
| D1110 |
Prophylaxis - adult |
3,530 |
3,477 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,837 |
3,802 |
$151K |
| D0330 |
Panoramic radiographic image |
2,214 |
2,182 |
$117K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,190 |
3,130 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
1,354 |
1,327 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,207 |
1,186 |
$37K |
| D3120 |
|
784 |
343 |
$29K |
| D2934 |
|
161 |
50 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
99 |
50 |
$8K |
| D9420 |
|
27 |
27 |
$3K |