| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,331 |
2,387 |
$1.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,998 |
5,209 |
$865K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,587 |
4,813 |
$644K |
| D1120 |
Prophylaxis - child |
27,094 |
22,903 |
$631K |
| D0120 |
Periodic oral evaluation - established patient |
29,225 |
24,337 |
$628K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,415 |
10,754 |
$487K |
| D1206 |
Topical application of fluoride varnish |
34,867 |
28,785 |
$466K |
| D1351 |
Sealant - per tooth |
16,726 |
3,971 |
$390K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,018 |
3,131 |
$384K |
| D0330 |
Panoramic radiographic image |
5,394 |
4,414 |
$252K |
| D1110 |
Prophylaxis - adult |
7,523 |
5,911 |
$228K |
| D0272 |
Bitewings - two radiographic images |
13,369 |
11,319 |
$208K |
| D2934 |
|
1,174 |
407 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,119 |
4,190 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
12,999 |
10,786 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,453 |
5,800 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,269 |
1,014 |
$148K |
| D0240 |
|
10,056 |
5,124 |
$136K |
| D9420 |
|
1,268 |
1,104 |
$132K |
| D1510 |
|
740 |
457 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,419 |
2,819 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,971 |
3,084 |
$97K |
| D2330 |
|
1,415 |
673 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
524 |
329 |
$52K |
| D0170 |
|
1,166 |
969 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
724 |
450 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
66 |
$11K |
| D9440 |
|
58 |
58 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
40 |
$783.25 |
| D1354 |
|
73 |
20 |
$302.50 |
| D9920 |
|
113 |
110 |
$215.00 |
| D0171 |
|
297 |
267 |
$0.00 |