| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,416 |
3,605 |
$2.26M |
| D1120 |
Prophylaxis - child |
33,859 |
30,115 |
$905K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,088 |
2,774 |
$795K |
| D1206 |
Topical application of fluoride varnish |
31,369 |
27,926 |
$708K |
| D2934 |
|
4,019 |
932 |
$703K |
| D0120 |
Periodic oral evaluation - established patient |
22,598 |
21,447 |
$618K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,127 |
1,803 |
$397K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,088 |
2,075 |
$349K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,891 |
1,556 |
$299K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,131 |
6,972 |
$274K |
| D1351 |
Sealant - per tooth |
10,232 |
1,918 |
$273K |
| D7240 |
Removal of impacted tooth - completely bony |
1,443 |
283 |
$259K |
| D0272 |
Bitewings - two radiographic images |
12,082 |
10,826 |
$202K |
| D0330 |
Panoramic radiographic image |
4,842 |
4,305 |
$195K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,303 |
4,303 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
3,989 |
3,555 |
$142K |
| D9310 |
|
2,600 |
2,293 |
$116K |
| D9420 |
|
550 |
515 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,850 |
2,580 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,952 |
2,693 |
$36K |
| D9222 |
|
431 |
302 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
531 |
300 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,607 |
1,445 |
$17K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
491 |
85 |
$9K |
| D0274 |
Bitewings - four radiographic images |
196 |
192 |
$6K |
| D1110 |
Prophylaxis - adult |
313 |
293 |
$4K |
| D9610 |
|
138 |
36 |
$0.00 |