| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,183 |
1,864 |
$531K |
| D1351 |
Sealant - per tooth |
17,325 |
3,667 |
$344K |
| D1120 |
Prophylaxis - child |
13,070 |
12,450 |
$324K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,481 |
3,135 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
13,918 |
13,325 |
$262K |
| D0240 |
|
18,120 |
9,809 |
$255K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,402 |
4,947 |
$249K |
| D1206 |
Topical application of fluoride varnish |
12,389 |
11,866 |
$195K |
| D1110 |
Prophylaxis - adult |
5,045 |
4,812 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,368 |
1,503 |
$161K |
| D9248 |
|
1,242 |
1,149 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
2,581 |
2,461 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,191 |
1,159 |
$105K |
| D0274 |
Bitewings - four radiographic images |
4,776 |
4,541 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,257 |
3,974 |
$91K |
| D0272 |
Bitewings - two radiographic images |
4,717 |
4,457 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,759 |
4,447 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,927 |
1,787 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,999 |
2,259 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,227 |
3,013 |
$28K |
| D4355 |
|
249 |
238 |
$24K |
| D1510 |
|
51 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D2330 |
|
16 |
13 |
$925.60 |
| D9110 |
|
31 |
27 |
$604.00 |
| D1999 |
|
4,485 |
3,947 |
$0.00 |
| D3120 |
|
759 |
472 |
$0.00 |
| D3110 |
|
70 |
43 |
$0.00 |