| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,611 |
4,007 |
$2.31M |
| D1120 |
Prophylaxis - child |
46,789 |
43,863 |
$1.91M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,461 |
5,670 |
$1.49M |
| D0120 |
Periodic oral evaluation - established patient |
38,928 |
36,469 |
$1.24M |
| D1206 |
Topical application of fluoride varnish |
46,456 |
43,499 |
$1.19M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,508 |
7,754 |
$959K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,721 |
4,969 |
$683K |
| D0140 |
Limited oral evaluation - problem focused |
13,532 |
12,467 |
$582K |
| D1351 |
Sealant - per tooth |
17,003 |
6,021 |
$576K |
| D0330 |
Panoramic radiographic image |
7,440 |
6,911 |
$526K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,002 |
8,109 |
$491K |
| D0272 |
Bitewings - two radiographic images |
12,132 |
11,381 |
$348K |
| D0274 |
Bitewings - four radiographic images |
6,507 |
6,074 |
$280K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,577 |
4,298 |
$266K |
| D9420 |
|
2,442 |
2,256 |
$207K |
| D0220 |
Intraoral - periapical first radiographic image |
11,355 |
10,383 |
$196K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,960 |
3,995 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
1,421 |
1,307 |
$116K |
| D0240 |
|
8,400 |
3,866 |
$115K |
| D9310 |
|
503 |
466 |
$15K |
| D2330 |
|
37 |
24 |
$3K |
| D8999 |
|
28 |
28 |
$3K |
| D2331 |
|
22 |
12 |
$2K |
| D0190 |
|
59 |
51 |
$2K |
| D0270 |
|
91 |
91 |
$1K |
| D1110 |
Prophylaxis - adult |
60 |
38 |
$0.00 |