| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,183 |
2,765 |
$1.14M |
| D1120 |
Prophylaxis - child |
23,919 |
23,384 |
$791K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,418 |
3,600 |
$626K |
| D1206 |
Topical application of fluoride varnish |
27,025 |
26,418 |
$562K |
| D0120 |
Periodic oral evaluation - established patient |
22,864 |
22,376 |
$552K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,774 |
3,055 |
$485K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,619 |
8,212 |
$245K |
| D0210 |
Intraoral - complete series of radiographic images |
4,054 |
3,971 |
$230K |
| D0272 |
Bitewings - two radiographic images |
10,151 |
9,867 |
$163K |
| D1351 |
Sealant - per tooth |
5,427 |
1,873 |
$158K |
| D1110 |
Prophylaxis - adult |
3,736 |
3,653 |
$158K |
| D0274 |
Bitewings - four radiographic images |
4,889 |
4,770 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
6,711 |
6,455 |
$81K |
| D9243 |
|
993 |
193 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,534 |
2,484 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
961 |
574 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,605 |
4,259 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,794 |
1,759 |
$40K |
| D9239 |
|
191 |
181 |
$15K |
| D2933 |
|
91 |
25 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
144 |
54 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
341 |
325 |
$7K |
| D3240 |
|
68 |
33 |
$6K |
| D2390 |
|
31 |
16 |
$5K |
| D1353 |
|
159 |
55 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
192 |
187 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
94 |
89 |
$2K |
| D9110 |
|
37 |
37 |
$1K |
| D1999 |
|
4,455 |
4,165 |
$0.00 |
| D9986 |
|
26 |
25 |
$0.00 |