| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,902 |
4,107 |
$1.16M |
| D1120 |
Prophylaxis - child |
36,571 |
35,727 |
$1.01M |
| D0120 |
Periodic oral evaluation - established patient |
35,305 |
34,572 |
$936K |
| D1206 |
Topical application of fluoride varnish |
45,387 |
44,347 |
$741K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,239 |
4,722 |
$675K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,513 |
14,079 |
$660K |
| D1351 |
Sealant - per tooth |
19,109 |
5,424 |
$550K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,187 |
4,257 |
$465K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,258 |
4,390 |
$431K |
| D1110 |
Prophylaxis - adult |
9,052 |
8,880 |
$356K |
| D0220 |
Intraoral - periapical first radiographic image |
22,288 |
21,614 |
$343K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,084 |
6,874 |
$322K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,866 |
2,478 |
$321K |
| D0140 |
Limited oral evaluation - problem focused |
7,745 |
7,396 |
$294K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,386 |
8,748 |
$274K |
| D0272 |
Bitewings - two radiographic images |
14,381 |
14,022 |
$264K |
| D0330 |
Panoramic radiographic image |
4,316 |
4,179 |
$219K |
| D0240 |
|
9,945 |
7,736 |
$164K |
| D0274 |
Bitewings - four radiographic images |
4,973 |
4,868 |
$161K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,764 |
2,692 |
$101K |
| D2330 |
|
772 |
447 |
$51K |
| D1517 |
|
146 |
146 |
$41K |
| D9420 |
|
329 |
323 |
$40K |
| D7111 |
|
504 |
360 |
$26K |
| D1516 |
|
39 |
39 |
$11K |
| D1354 |
|
722 |
344 |
$5K |
| D2331 |
|
21 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
24 |
$435.84 |