| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
33,183 |
6,845 |
$2.09M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,244 |
1,810 |
$847K |
| D1351 |
Sealant - per tooth |
19,667 |
4,855 |
$507K |
| D1120 |
Prophylaxis - child |
12,247 |
10,931 |
$388K |
| D1206 |
Topical application of fluoride varnish |
16,131 |
14,429 |
$323K |
| D0120 |
Periodic oral evaluation - established patient |
12,621 |
11,362 |
$275K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,074 |
1,268 |
$248K |
| D1110 |
Prophylaxis - adult |
4,053 |
3,645 |
$185K |
| D0240 |
|
12,814 |
5,303 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,908 |
3,450 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,383 |
1,326 |
$131K |
| D0272 |
Bitewings - two radiographic images |
5,923 |
5,332 |
$124K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,053 |
3,427 |
$109K |
| D0330 |
Panoramic radiographic image |
2,118 |
1,875 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,053 |
630 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
4,527 |
2,500 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,066 |
1,844 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,551 |
1,376 |
$44K |
| D7111 |
|
428 |
242 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,208 |
2,703 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,334 |
1,287 |
$23K |
| D1510 |
|
104 |
65 |
$17K |
| D1517 |
|
42 |
37 |
$12K |
| D2934 |
|
36 |
13 |
$6K |
| D1516 |
|
15 |
12 |
$4K |
| D2330 |
|
44 |
26 |
$3K |