| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,746 |
1,266 |
$508K |
| D1120 |
Prophylaxis - child |
14,274 |
13,829 |
$475K |
| D1206 |
Topical application of fluoride varnish |
18,506 |
17,991 |
$392K |
| D0120 |
Periodic oral evaluation - established patient |
15,004 |
14,514 |
$364K |
| D1110 |
Prophylaxis - adult |
4,926 |
4,783 |
$209K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,779 |
1,206 |
$165K |
| D0330 |
Panoramic radiographic image |
3,832 |
3,717 |
$143K |
| D0272 |
Bitewings - two radiographic images |
8,352 |
8,087 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,423 |
4,293 |
$125K |
| D9248 |
|
805 |
768 |
$65K |
| D1351 |
Sealant - per tooth |
1,976 |
630 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
830 |
579 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,707 |
1,636 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
555 |
397 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,352 |
1,315 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,908 |
2,754 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,464 |
1,399 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
409 |
169 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,046 |
944 |
$19K |
| D2929 |
|
142 |
46 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,809 |
758 |
$15K |
| D1510 |
|
43 |
25 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
271 |
264 |
$5K |
| D1354 |
|
104 |
38 |
$961.27 |