| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,821 |
4,141 |
$1.94M |
| D1120 |
Prophylaxis - child |
33,722 |
33,362 |
$1.24M |
| D0120 |
Periodic oral evaluation - established patient |
36,110 |
35,740 |
$1.03M |
| D1208 |
Topical application of fluoride, excluding varnish |
25,420 |
25,109 |
$526K |
| D1206 |
Topical application of fluoride varnish |
20,141 |
19,962 |
$520K |
| D0272 |
Bitewings - two radiographic images |
21,173 |
20,896 |
$447K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,185 |
3,225 |
$441K |
| D9248 |
|
2,784 |
2,572 |
$345K |
| D1351 |
Sealant - per tooth |
10,922 |
3,216 |
$337K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,293 |
6,246 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,057 |
2,114 |
$303K |
| D0220 |
Intraoral - periapical first radiographic image |
14,632 |
13,858 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,722 |
3,657 |
$190K |
| D1110 |
Prophylaxis - adult |
3,676 |
3,640 |
$179K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,010 |
3,786 |
$142K |
| D0330 |
Panoramic radiographic image |
2,283 |
2,256 |
$137K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,280 |
9,007 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,496 |
1,051 |
$98K |
| D9420 |
|
702 |
664 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,472 |
1,439 |
$21K |
| D9920 |
|
244 |
220 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
98 |
65 |
$9K |
| D2330 |
|
45 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
28 |
$3K |
| D2140 |
|
31 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |