| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,207 |
1,859 |
$1.88M |
| D1120 |
Prophylaxis - child |
16,254 |
15,050 |
$639K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,488 |
3,316 |
$508K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,145 |
1,663 |
$429K |
| D0120 |
Periodic oral evaluation - established patient |
13,780 |
12,635 |
$398K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,881 |
14,681 |
$391K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,912 |
2,130 |
$362K |
| D0330 |
Panoramic radiographic image |
3,272 |
3,047 |
$192K |
| D0140 |
Limited oral evaluation - problem focused |
3,503 |
3,325 |
$152K |
| D0272 |
Bitewings - two radiographic images |
5,167 |
4,826 |
$144K |
| D0274 |
Bitewings - four radiographic images |
3,235 |
2,941 |
$122K |
| D9420 |
|
1,364 |
1,280 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,023 |
1,873 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,457 |
1,316 |
$81K |
| D1351 |
Sealant - per tooth |
2,264 |
875 |
$72K |
| D8670 |
Periodic orthodontic treatment visit |
5,944 |
5,886 |
$69K |
| D2934 |
|
460 |
63 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
535 |
290 |
$63K |
| D1510 |
|
179 |
97 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,219 |
1,132 |
$20K |
| D2330 |
|
168 |
89 |
$15K |
| D1110 |
Prophylaxis - adult |
213 |
189 |
$5K |
| D7111 |
|
50 |
26 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$2K |
| D8660 |
|
64 |
57 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
47 |
$909.84 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$590.85 |
| D1999 |
|
133 |
129 |
$0.00 |
| D9110 |
|
13 |
13 |
$0.00 |
| D0160 |
|
13 |
13 |
$0.00 |
| D0601 |
|
37 |
37 |
$0.00 |
| D3120 |
|
51 |
24 |
$0.00 |
| D0603 |
|
330 |
326 |
$0.00 |
| D0602 |
|
109 |
108 |
$0.00 |