| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33,400 |
6,799 |
$4.49M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,533 |
8,003 |
$1.34M |
| D1120 |
Prophylaxis - child |
52,820 |
48,735 |
$1.29M |
| D0120 |
Periodic oral evaluation - established patient |
45,774 |
42,412 |
$1.10M |
| D1206 |
Topical application of fluoride varnish |
59,896 |
55,382 |
$873K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,573 |
16,951 |
$772K |
| D1351 |
Sealant - per tooth |
29,646 |
9,193 |
$646K |
| D2933 |
|
3,338 |
794 |
$586K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,171 |
12,200 |
$543K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,041 |
2,890 |
$520K |
| D0272 |
Bitewings - two radiographic images |
25,589 |
23,636 |
$428K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,607 |
12,915 |
$372K |
| D9420 |
|
3,285 |
3,026 |
$352K |
| D0330 |
Panoramic radiographic image |
7,021 |
6,522 |
$349K |
| D1110 |
Prophylaxis - adult |
7,899 |
7,358 |
$276K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,733 |
2,197 |
$275K |
| D0220 |
Intraoral - periapical first radiographic image |
19,647 |
18,009 |
$274K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,203 |
1,120 |
$161K |
| D0274 |
Bitewings - four radiographic images |
3,702 |
3,445 |
$100K |
| D1354 |
|
15,334 |
4,375 |
$96K |
| D2934 |
|
354 |
71 |
$53K |
| D1510 |
|
229 |
176 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,148 |
1,073 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
517 |
$19K |
| D1517 |
|
52 |
50 |
$14K |
| D1516 |
|
40 |
40 |
$11K |
| D4355 |
|
80 |
78 |
$5K |
| D7111 |
|
59 |
25 |
$2K |
| D2330 |
|
16 |
14 |
$876.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
33 |
16 |
$86.45 |
| D1999 |
|
6,676 |
6,417 |
$0.00 |
| D1353 |
|
3,756 |
1,062 |
$0.00 |
| D9215 |
|
1,676 |
1,288 |
$0.00 |