| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,395 |
4,778 |
$2.57M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,640 |
4,372 |
$1.09M |
| D1120 |
Prophylaxis - child |
20,247 |
20,191 |
$818K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,490 |
4,046 |
$676K |
| D2390 |
|
3,185 |
1,326 |
$626K |
| D1206 |
Topical application of fluoride varnish |
20,498 |
20,437 |
$541K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,150 |
2,215 |
$531K |
| D0120 |
Periodic oral evaluation - established patient |
17,034 |
17,008 |
$506K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,236 |
3,168 |
$494K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,482 |
9,485 |
$436K |
| D1351 |
Sealant - per tooth |
8,030 |
2,401 |
$248K |
| D1510 |
|
1,175 |
925 |
$227K |
| D0220 |
Intraoral - periapical first radiographic image |
12,264 |
12,142 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,740 |
3,699 |
$181K |
| D0140 |
Limited oral evaluation - problem focused |
3,051 |
3,020 |
$178K |
| D0272 |
Bitewings - two radiographic images |
4,351 |
4,338 |
$103K |
| D2934 |
|
345 |
139 |
$83K |
| D2330 |
|
657 |
471 |
$56K |
| D0330 |
Panoramic radiographic image |
629 |
629 |
$42K |
| D9310 |
|
543 |
542 |
$37K |
| D1110 |
Prophylaxis - adult |
682 |
681 |
$35K |
| D0274 |
Bitewings - four radiographic images |
665 |
664 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
571 |
571 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
89 |
$18K |
| D7111 |
|
193 |
124 |
$14K |
| D9248 |
|
179 |
172 |
$10K |
| D2332 |
|
53 |
38 |
$7K |
| D2331 |
|
13 |
12 |
$1K |