| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
15,322 |
3,094 |
$575K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,302 |
499 |
$154K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,649 |
738 |
$144K |
| D1120 |
Prophylaxis - child |
2,876 |
2,798 |
$77K |
| D1206 |
Topical application of fluoride varnish |
2,752 |
2,666 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,151 |
2,055 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
540 |
276 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,044 |
2,937 |
$58K |
| D1351 |
Sealant - per tooth |
2,801 |
702 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,475 |
2,428 |
$48K |
| D1110 |
Prophylaxis - adult |
1,166 |
1,126 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,328 |
3,213 |
$36K |
| D0330 |
Panoramic radiographic image |
853 |
833 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,635 |
1,606 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
391 |
248 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
744 |
700 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
157 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,204 |
1,170 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
14 |
$16K |
| D0274 |
Bitewings - four radiographic images |
559 |
539 |
$11K |
| D2332 |
|
109 |
59 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
349 |
307 |
$9K |
| D2394 |
|
38 |
27 |
$5K |
| D2950 |
|
45 |
12 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$567.00 |