| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,081 |
1,772 |
$1.25M |
| D1351 |
Sealant - per tooth |
8,545 |
1,680 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,516 |
1,247 |
$220K |
| D1120 |
Prophylaxis - child |
6,339 |
6,287 |
$219K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,487 |
1,477 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,306 |
1,413 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
7,099 |
7,038 |
$191K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,084 |
749 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,604 |
7,853 |
$148K |
| D0272 |
Bitewings - two radiographic images |
6,133 |
6,023 |
$130K |
| D1206 |
Topical application of fluoride varnish |
8,885 |
8,809 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
9,375 |
9,099 |
$120K |
| D1110 |
Prophylaxis - adult |
1,947 |
1,936 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
3,303 |
3,252 |
$83K |
| D9248 |
|
822 |
789 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,553 |
2,467 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
883 |
511 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,480 |
1,473 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,190 |
1,185 |
$40K |
| D2335 |
|
272 |
109 |
$35K |
| D2332 |
|
239 |
123 |
$27K |
| D2934 |
|
154 |
37 |
$22K |
| D1510 |
|
145 |
99 |
$22K |
| D9420 |
|
1,047 |
1,023 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
205 |
$11K |
| D0603 |
|
10,046 |
9,968 |
$7K |
| D2330 |
|
68 |
42 |
$5K |
| D1999 |
|
18 |
17 |
$0.00 |