| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,970 |
1,486 |
$768K |
| D1120 |
Prophylaxis - child |
14,045 |
13,821 |
$484K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,221 |
13,033 |
$447K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,477 |
2,106 |
$442K |
| D1206 |
Topical application of fluoride varnish |
17,106 |
16,850 |
$332K |
| D0120 |
Periodic oral evaluation - established patient |
12,657 |
12,590 |
$306K |
| D1351 |
Sealant - per tooth |
7,953 |
2,300 |
$286K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,083 |
1,208 |
$212K |
| D0220 |
Intraoral - periapical first radiographic image |
14,410 |
14,216 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,825 |
3,802 |
$155K |
| D1110 |
Prophylaxis - adult |
3,160 |
3,132 |
$149K |
| D0272 |
Bitewings - two radiographic images |
6,479 |
6,452 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,011 |
677 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,437 |
3,294 |
$107K |
| D0240 |
|
2,558 |
2,556 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
3,343 |
3,304 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
769 |
303 |
$66K |
| D2934 |
|
270 |
80 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,157 |
1,142 |
$40K |
| D9420 |
|
337 |
337 |
$37K |
| D0274 |
Bitewings - four radiographic images |
816 |
808 |
$25K |
| D1510 |
|
34 |
28 |
$5K |
| D2331 |
|
19 |
12 |
$2K |
| D9310 |
|
12 |
12 |
$500.52 |