| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,810 |
1,541 |
$534K |
| D1351 |
Sealant - per tooth |
19,515 |
4,728 |
$445K |
| D1120 |
Prophylaxis - child |
14,290 |
13,214 |
$397K |
| D1206 |
Topical application of fluoride varnish |
18,975 |
17,577 |
$344K |
| D0120 |
Periodic oral evaluation - established patient |
16,675 |
15,462 |
$312K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,385 |
1,992 |
$268K |
| D1110 |
Prophylaxis - adult |
5,115 |
4,782 |
$199K |
| D0272 |
Bitewings - two radiographic images |
6,644 |
6,084 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,305 |
1,413 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
2,530 |
2,397 |
$100K |
| D0330 |
Panoramic radiographic image |
2,655 |
2,417 |
$93K |
| D1354 |
|
1,099 |
463 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,614 |
2,435 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,048 |
2,762 |
$73K |
| D9248 |
|
1,792 |
1,475 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,073 |
1,942 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
573 |
382 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
736 |
706 |
$23K |
| D2332 |
|
105 |
52 |
$8K |
| D1516 |
|
22 |
17 |
$5K |
| D1517 |
|
18 |
14 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
422 |
360 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
51 |
25 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
67 |
$2K |
| D1515 |
|
53 |
40 |
$0.00 |