| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,519 |
1,820 |
$1.25M |
| D1120 |
Prophylaxis - child |
23,335 |
23,235 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
11,966 |
11,871 |
$790K |
| D1310 |
|
15,438 |
15,371 |
$701K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,390 |
3,941 |
$691K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,130 |
7,102 |
$479K |
| D1206 |
Topical application of fluoride varnish |
21,340 |
21,248 |
$470K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,915 |
1,337 |
$387K |
| D0230 |
Intraoral - periapical each additional radiographic image |
94,789 |
13,897 |
$387K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,692 |
4,673 |
$318K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,806 |
2,373 |
$273K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,360 |
6,033 |
$252K |
| D0603 |
|
15,443 |
15,378 |
$229K |
| D1351 |
Sealant - per tooth |
4,258 |
1,410 |
$153K |
| D9920 |
|
926 |
899 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,159 |
1,081 |
$117K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,455 |
1,073 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
9,131 |
8,908 |
$108K |
| D9993 |
|
2,793 |
2,790 |
$72K |
| D9430 |
|
2,049 |
1,967 |
$65K |
| D2330 |
|
776 |
316 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,907 |
1,904 |
$54K |
| D0330 |
Panoramic radiographic image |
1,848 |
1,842 |
$54K |
| D0272 |
Bitewings - two radiographic images |
4,205 |
4,131 |
$49K |
| D0350 |
|
4,065 |
1,384 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,935 |
1,933 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
938 |
938 |
$32K |
| D0340 |
|
625 |
625 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
449 |
449 |
$20K |
| D0240 |
|
54 |
33 |
$510.00 |
| D1330 |
|
656 |
656 |
$0.00 |
| D9310 |
|
22 |
22 |
$0.00 |