| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,719 |
1,185 |
$532K |
| D1120 |
Prophylaxis - child |
10,345 |
10,110 |
$316K |
| D1206 |
Topical application of fluoride varnish |
12,390 |
11,914 |
$218K |
| D0272 |
Bitewings - two radiographic images |
10,003 |
9,434 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
8,898 |
8,688 |
$193K |
| D1351 |
Sealant - per tooth |
6,073 |
1,166 |
$152K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,593 |
720 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,835 |
1,060 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,780 |
933 |
$120K |
| D0240 |
|
6,265 |
3,131 |
$110K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,427 |
2,186 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,119 |
2,069 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,359 |
1,305 |
$40K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
185 |
158 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
367 |
169 |
$21K |
| D0330 |
Panoramic radiographic image |
341 |
334 |
$16K |
| D9310 |
|
582 |
569 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,168 |
1,120 |
$14K |
| D0274 |
Bitewings - four radiographic images |
461 |
454 |
$14K |
| D2934 |
|
106 |
41 |
$14K |
| D9222 |
|
163 |
158 |
$13K |
| D2390 |
|
81 |
25 |
$12K |
| D1110 |
Prophylaxis - adult |
214 |
210 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
674 |
240 |
$7K |
| D2330 |
|
61 |
27 |
$4K |
| D9610 |
|
163 |
158 |
$3K |