| Code | Description | Claims | Beneficiaries | Total Paid |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,397 |
3,097 |
$1.72M |
| D0145 |
Oral evaluation for a patient under three years of age |
7,538 |
7,463 |
$1.04M |
| D1351 |
Sealant - per tooth |
29,883 |
5,947 |
$788K |
| D0120 |
Periodic oral evaluation - established patient |
27,479 |
26,933 |
$758K |
| D1120 |
Prophylaxis - child |
20,396 |
20,048 |
$714K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,786 |
2,872 |
$450K |
| D1110 |
Prophylaxis - adult |
8,436 |
8,295 |
$439K |
| D9248 |
|
3,759 |
3,652 |
$429K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,817 |
27,288 |
$392K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,797 |
3,140 |
$355K |
| D0330 |
Panoramic radiographic image |
4,584 |
4,500 |
$241K |
| D0272 |
Bitewings - two radiographic images |
10,757 |
10,480 |
$234K |
| D0274 |
Bitewings - four radiographic images |
4,669 |
4,559 |
$151K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,609 |
1,387 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,068 |
3,976 |
$135K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,401 |
726 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,219 |
3,975 |
$106K |
| D2934 |
|
718 |
205 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
8,221 |
7,874 |
$94K |
| D9420 |
|
1,461 |
1,410 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,551 |
1,534 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,047 |
1,934 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
79 |
$10K |
| D1206 |
Topical application of fluoride varnish |
449 |
440 |
$6K |
| D2330 |
|
67 |
53 |
$4K |
| D9430 |
|
158 |
152 |
$1K |
| D1330 |
|
95 |
95 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$918.63 |
| D7111 |
|
23 |
18 |
$263.81 |
| D0270 |
|
29 |
27 |
$117.11 |
| D0603 |
|
39,539 |
38,871 |
$0.00 |