| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,542 |
3,144 |
$1.54M |
| D7140 |
Extraction, erupted tooth or exposed root |
7,728 |
2,690 |
$497K |
| D1206 |
Topical application of fluoride varnish |
21,149 |
20,172 |
$478K |
| D1120 |
Prophylaxis - child |
16,815 |
16,577 |
$423K |
| D1351 |
Sealant - per tooth |
13,703 |
4,069 |
$336K |
| D0120 |
Periodic oral evaluation - established patient |
13,081 |
12,925 |
$284K |
| D9420 |
|
2,085 |
2,030 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,330 |
1,482 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
5,188 |
5,081 |
$125K |
| D0272 |
Bitewings - two radiographic images |
10,684 |
10,521 |
$117K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,797 |
3,667 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
2,067 |
2,043 |
$95K |
| D1999 |
|
9,434 |
9,141 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,931 |
3,846 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,089 |
5,087 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
913 |
639 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
7,914 |
7,536 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
880 |
854 |
$31K |
| D0330 |
Panoramic radiographic image |
2,216 |
2,165 |
$22K |
| D1110 |
Prophylaxis - adult |
638 |
615 |
$21K |
| D2929 |
|
111 |
39 |
$17K |
| D0274 |
Bitewings - four radiographic images |
971 |
955 |
$15K |
| D2330 |
|
40 |
24 |
$3K |
| D1354 |
|
128 |
50 |
$1K |
| D7111 |
|
40 |
17 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$844.76 |
| D9248 |
|
12 |
12 |
$534.67 |
| D9997 |
|
308 |
299 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
18 |
18 |
$0.00 |