| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,743 |
2,080 |
$1.11M |
| D1120 |
Prophylaxis - child |
26,948 |
26,904 |
$786K |
| D1206 |
Topical application of fluoride varnish |
30,332 |
29,554 |
$772K |
| D0120 |
Periodic oral evaluation - established patient |
22,024 |
21,988 |
$545K |
| D1351 |
Sealant - per tooth |
11,700 |
2,477 |
$315K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,818 |
3,811 |
$162K |
| D0272 |
Bitewings - two radiographic images |
10,522 |
10,497 |
$152K |
| D1999 |
|
13,649 |
13,589 |
$136K |
| D9420 |
|
755 |
747 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,212 |
2,177 |
$68K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
806 |
327 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
855 |
392 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,210 |
2,206 |
$52K |
| D0240 |
|
6,280 |
3,142 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,020 |
2,017 |
$42K |
| D0330 |
Panoramic radiographic image |
984 |
981 |
$41K |
| D1110 |
Prophylaxis - adult |
1,110 |
1,107 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,148 |
3,069 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
268 |
149 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
807 |
803 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,391 |
1,227 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
102 |
$11K |
| D2929 |
|
39 |
13 |
$6K |