| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21,570 |
6,739 |
$2.92M |
| D1120 |
Prophylaxis - child |
81,918 |
74,423 |
$2.08M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,960 |
12,641 |
$2.05M |
| D0120 |
Periodic oral evaluation - established patient |
65,632 |
60,010 |
$1.57M |
| D1206 |
Topical application of fluoride varnish |
81,324 |
73,279 |
$1.20M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29,596 |
25,794 |
$1.19M |
| D1351 |
Sealant - per tooth |
45,416 |
11,653 |
$1.17M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,114 |
6,185 |
$942K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,101 |
7,143 |
$804K |
| D0272 |
Bitewings - two radiographic images |
34,007 |
31,274 |
$573K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,035 |
12,734 |
$564K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,529 |
16,876 |
$466K |
| D0220 |
Intraoral - periapical first radiographic image |
32,987 |
29,963 |
$448K |
| D1110 |
Prophylaxis - adult |
10,313 |
9,552 |
$387K |
| D0240 |
|
25,325 |
13,381 |
$387K |
| D9420 |
|
3,110 |
2,918 |
$346K |
| D0140 |
Limited oral evaluation - problem focused |
9,233 |
8,629 |
$327K |
| D0330 |
Panoramic radiographic image |
5,981 |
5,580 |
$312K |
| D0145 |
Oral evaluation for a patient under three years of age |
8,274 |
6,989 |
$273K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,706 |
1,166 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,617 |
8,036 |
$126K |
| D2390 |
|
737 |
259 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,338 |
2,977 |
$94K |
| D2934 |
|
486 |
131 |
$90K |
| D1510 |
|
341 |
201 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
309 |
197 |
$35K |
| D2330 |
|
328 |
171 |
$20K |
| D2929 |
|
85 |
25 |
$15K |
| D2331 |
|
91 |
54 |
$6K |
| D1354 |
|
548 |
212 |
$4K |
| D2332 |
|
39 |
24 |
$4K |
| D9971 |
|
46 |
13 |
$0.00 |
| D1999 |
|
483 |
358 |
$0.00 |