| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,492 |
3,343 |
$1.87M |
| D1120 |
Prophylaxis - child |
26,864 |
20,957 |
$953K |
| D0120 |
Periodic oral evaluation - established patient |
26,689 |
20,841 |
$747K |
| D1351 |
Sealant - per tooth |
26,937 |
5,563 |
$695K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,377 |
18,182 |
$466K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,389 |
2,555 |
$453K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,634 |
2,431 |
$440K |
| D1110 |
Prophylaxis - adult |
8,742 |
6,878 |
$430K |
| D0210 |
Intraoral - complete series of radiographic images |
5,958 |
4,593 |
$335K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,008 |
2,462 |
$299K |
| D1206 |
Topical application of fluoride varnish |
11,746 |
9,283 |
$297K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,117 |
1,210 |
$293K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,702 |
6,004 |
$284K |
| D9248 |
|
2,295 |
1,711 |
$276K |
| D0330 |
Panoramic radiographic image |
4,444 |
3,721 |
$254K |
| D0272 |
Bitewings - two radiographic images |
11,494 |
9,132 |
$251K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,516 |
3,537 |
$216K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,066 |
3,187 |
$204K |
| D0220 |
Intraoral - periapical first radiographic image |
14,694 |
11,427 |
$202K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,133 |
6,242 |
$194K |
| D9420 |
|
981 |
754 |
$77K |
| D2929 |
|
217 |
51 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
4,137 |
3,148 |
$46K |
| D2330 |
|
230 |
123 |
$20K |
| D3120 |
|
225 |
168 |
$0.00 |