| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,853 |
4,498 |
$1.72M |
| D1120 |
Prophylaxis - child |
46,341 |
46,046 |
$1.45M |
| D1208 |
Topical application of fluoride, excluding varnish |
46,169 |
45,878 |
$832K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,572 |
21,427 |
$751K |
| D2932 |
|
4,363 |
1,169 |
$573K |
| D0120 |
Periodic oral evaluation - established patient |
25,344 |
25,213 |
$570K |
| D0272 |
Bitewings - two radiographic images |
27,220 |
27,031 |
$528K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,396 |
4,444 |
$463K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,567 |
3,428 |
$430K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,516 |
13,866 |
$393K |
| D0274 |
Bitewings - four radiographic images |
12,281 |
12,187 |
$359K |
| D0240 |
|
22,597 |
16,661 |
$355K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,554 |
3,303 |
$246K |
| D1351 |
Sealant - per tooth |
10,207 |
2,937 |
$240K |
| D9420 |
|
2,517 |
2,400 |
$177K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,932 |
880 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
4,084 |
4,028 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
7,806 |
7,692 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,288 |
4,481 |
$82K |
| D9920 |
|
813 |
783 |
$79K |
| D0330 |
Panoramic radiographic image |
2,708 |
2,682 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
858 |
582 |
$60K |
| D1510 |
|
431 |
295 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,095 |
1,084 |
$53K |
| D2140 |
|
463 |
312 |
$25K |
| D1110 |
Prophylaxis - adult |
303 |
303 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
115 |
$11K |
| D2331 |
|
37 |
24 |
$3K |
| D2330 |
|
36 |
25 |
$3K |
| D7111 |
|
19 |
13 |
$976.06 |