| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
24,823 |
8,282 |
$2.89M |
| D1120 |
Prophylaxis - child |
37,597 |
36,907 |
$1.98M |
| D7140 |
Extraction, erupted tooth or exposed root |
21,549 |
8,618 |
$1.17M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33,559 |
33,061 |
$965K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,185 |
6,094 |
$838K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,065 |
8,047 |
$832K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,522 |
4,298 |
$630K |
| D1206 |
Topical application of fluoride varnish |
39,814 |
39,102 |
$615K |
| D9248 |
|
8,198 |
8,029 |
$579K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,086 |
14,680 |
$560K |
| D1351 |
Sealant - per tooth |
25,072 |
9,242 |
$478K |
| D0330 |
Panoramic radiographic image |
9,882 |
9,742 |
$458K |
| D0272 |
Bitewings - two radiographic images |
21,527 |
21,102 |
$392K |
| D2332 |
|
2,905 |
1,737 |
$238K |
| D2330 |
|
3,916 |
2,301 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
8,341 |
8,163 |
$213K |
| D0220 |
Intraoral - periapical first radiographic image |
17,512 |
16,986 |
$173K |
| D1110 |
Prophylaxis - adult |
2,369 |
2,331 |
$125K |
| D1354 |
|
12,640 |
4,889 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,069 |
7,061 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,163 |
3,108 |
$95K |
| D7111 |
|
1,573 |
917 |
$91K |
| D1330 |
|
3,974 |
3,905 |
$36K |
| D1353 |
|
1,688 |
819 |
$27K |
| D9110 |
|
416 |
408 |
$15K |
| D2931 |
|
114 |
75 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
55 |
$2K |
| D9420 |
|
16 |
15 |
$1K |
| D0603 |
|
2,855 |
2,702 |
$0.00 |