| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,743 |
2,407 |
$1.24M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,988 |
3,643 |
$555K |
| D1120 |
Prophylaxis - child |
22,938 |
22,367 |
$516K |
| D0120 |
Periodic oral evaluation - established patient |
23,930 |
23,413 |
$471K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,931 |
3,177 |
$298K |
| D1206 |
Topical application of fluoride varnish |
14,458 |
14,191 |
$257K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,277 |
2,871 |
$236K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,981 |
10,654 |
$178K |
| D0240 |
|
15,452 |
6,545 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,851 |
5,671 |
$173K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,431 |
5,837 |
$173K |
| D0272 |
Bitewings - two radiographic images |
13,732 |
13,357 |
$156K |
| D1110 |
Prophylaxis - adult |
3,285 |
3,227 |
$128K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,660 |
965 |
$112K |
| D1351 |
Sealant - per tooth |
3,650 |
1,088 |
$101K |
| D0330 |
Panoramic radiographic image |
1,633 |
1,575 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,697 |
3,742 |
$64K |
| D2934 |
|
275 |
105 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,798 |
1,747 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
6,043 |
5,786 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,434 |
1,410 |
$33K |
| D2331 |
|
439 |
278 |
$31K |
| D2330 |
|
305 |
170 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
311 |
206 |
$17K |
| D2140 |
|
264 |
179 |
$10K |
| D2335 |
|
81 |
37 |
$8K |
| D2332 |
|
54 |
39 |
$4K |
| D1999 |
|
390 |
363 |
$0.00 |