| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,905 |
3,396 |
$1.11M |
| D1120 |
Prophylaxis - child |
40,199 |
39,437 |
$1.04M |
| D0120 |
Periodic oral evaluation - established patient |
38,076 |
37,370 |
$721K |
| D1206 |
Topical application of fluoride varnish |
44,467 |
43,589 |
$691K |
| D1351 |
Sealant - per tooth |
16,093 |
3,785 |
$343K |
| D0272 |
Bitewings - two radiographic images |
17,034 |
16,653 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,979 |
2,168 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,323 |
2,290 |
$178K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,288 |
7,869 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,199 |
1,544 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,099 |
5,903 |
$140K |
| D1110 |
Prophylaxis - adult |
3,288 |
3,213 |
$128K |
| D0330 |
Panoramic radiographic image |
3,434 |
3,335 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
9,206 |
8,944 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
2,514 |
2,444 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,639 |
5,024 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,829 |
1,796 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
698 |
684 |
$35K |
| D9420 |
|
744 |
737 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
256 |
248 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
77 |
51 |
$4K |
| D1510 |
|
14 |
12 |
$1K |
| D0270 |
|
142 |
136 |
$825.42 |
| D2330 |
|
19 |
13 |
$730.66 |
| D1354 |
|
32 |
13 |
$198.40 |