| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,317 |
4,549 |
$2.03M |
| D1120 |
Prophylaxis - child |
34,309 |
33,707 |
$1.12M |
| D1351 |
Sealant - per tooth |
28,315 |
5,559 |
$742K |
| D1206 |
Topical application of fluoride varnish |
39,725 |
38,561 |
$742K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,142 |
5,294 |
$708K |
| D0120 |
Periodic oral evaluation - established patient |
30,599 |
30,024 |
$703K |
| D0272 |
Bitewings - two radiographic images |
30,185 |
28,995 |
$646K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,220 |
3,451 |
$629K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,779 |
3,887 |
$488K |
| D0240 |
|
16,426 |
8,907 |
$293K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,911 |
8,006 |
$268K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,834 |
1,402 |
$169K |
| D2330 |
|
2,367 |
890 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,223 |
5,108 |
$163K |
| D0140 |
Limited oral evaluation - problem focused |
5,271 |
5,117 |
$157K |
| D0274 |
Bitewings - four radiographic images |
4,274 |
4,192 |
$136K |
| D1110 |
Prophylaxis - adult |
3,038 |
2,979 |
$132K |
| D0330 |
Panoramic radiographic image |
2,732 |
2,677 |
$106K |
| D9420 |
|
840 |
818 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
4,978 |
4,845 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,638 |
1,899 |
$55K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,824 |
1,786 |
$53K |
| D2934 |
|
341 |
132 |
$46K |
| D1354 |
|
2,133 |
752 |
$29K |
| D2331 |
|
337 |
214 |
$27K |
| D2390 |
|
71 |
25 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
78 |
$8K |
| D9310 |
|
257 |
246 |
$7K |
| D1510 |
|
33 |
24 |
$5K |
| D7961 |
|
13 |
13 |
$2K |