| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18,159 |
6,549 |
$1.86M |
| D1120 |
Prophylaxis - child |
55,422 |
53,187 |
$1.75M |
| D0120 |
Periodic oral evaluation - established patient |
58,658 |
56,316 |
$1.33M |
| D1206 |
Topical application of fluoride varnish |
57,492 |
55,173 |
$1.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,909 |
6,269 |
$608K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,974 |
6,358 |
$512K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,437 |
17,748 |
$510K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,420 |
2,654 |
$484K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,888 |
13,345 |
$383K |
| D0330 |
Panoramic radiographic image |
10,158 |
9,761 |
$364K |
| D1110 |
Prophylaxis - adult |
8,741 |
8,412 |
$349K |
| D0272 |
Bitewings - two radiographic images |
20,071 |
19,198 |
$340K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,814 |
11,662 |
$316K |
| D1351 |
Sealant - per tooth |
11,637 |
3,927 |
$308K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,618 |
2,301 |
$244K |
| D0220 |
Intraoral - periapical first radiographic image |
16,609 |
15,569 |
$194K |
| D9248 |
|
2,065 |
1,917 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
6,528 |
6,143 |
$138K |
| D0274 |
Bitewings - four radiographic images |
5,081 |
4,878 |
$131K |
| D1354 |
|
9,580 |
2,430 |
$51K |
| D2140 |
|
170 |
133 |
$10K |
| D2934 |
|
78 |
26 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
15 |
$1K |
| D2940 |
|
21 |
16 |
$803.36 |