| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,680 |
992 |
$608K |
| D1206 |
Topical application of fluoride varnish |
8,468 |
8,303 |
$223K |
| D1120 |
Prophylaxis - child |
7,306 |
7,164 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
6,877 |
6,752 |
$175K |
| D1351 |
Sealant - per tooth |
4,465 |
1,313 |
$126K |
| D0272 |
Bitewings - two radiographic images |
5,189 |
5,081 |
$73K |
| D9420 |
|
583 |
561 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,636 |
1,469 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
678 |
413 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,447 |
1,405 |
$29K |
| D1110 |
Prophylaxis - adult |
634 |
625 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
659 |
642 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
580 |
571 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,174 |
2,083 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
63 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,830 |
1,298 |
$11K |
| D0330 |
Panoramic radiographic image |
508 |
494 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
161 |
161 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
155 |
152 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
75 |
30 |
$7K |
| D2929 |
|
46 |
14 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
39 |
$4K |
| D2330 |
|
24 |
14 |
$1K |