| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,170 |
2,522 |
$1.09M |
| D1120 |
Prophylaxis - child |
17,406 |
16,500 |
$584K |
| D1206 |
Topical application of fluoride varnish |
20,850 |
19,688 |
$440K |
| D0120 |
Periodic oral evaluation - established patient |
16,360 |
15,484 |
$366K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,834 |
2,138 |
$342K |
| D1354 |
|
3,315 |
924 |
$237K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,266 |
5,556 |
$176K |
| D1110 |
Prophylaxis - adult |
3,630 |
3,426 |
$167K |
| D1351 |
Sealant - per tooth |
6,273 |
1,656 |
$164K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,181 |
1,397 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,740 |
1,654 |
$140K |
| D0272 |
Bitewings - two radiographic images |
5,483 |
5,135 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
3,811 |
3,444 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,282 |
3,074 |
$108K |
| D0330 |
Panoramic radiographic image |
1,455 |
1,366 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,182 |
1,115 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
986 |
954 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,072 |
2,734 |
$30K |
| D0240 |
|
1,795 |
1,091 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,200 |
1,227 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
464 |
367 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
72 |
54 |
$7K |
| D1510 |
|
70 |
39 |
$6K |
| D2330 |
|
66 |
46 |
$4K |
| D1999 |
|
334 |
304 |
$540.00 |