| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
8,409 |
2,483 |
$525K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,907 |
1,071 |
$256K |
| D1351 |
Sealant - per tooth |
6,138 |
1,375 |
$158K |
| D1120 |
Prophylaxis - child |
3,979 |
3,630 |
$132K |
| D1206 |
Topical application of fluoride varnish |
6,060 |
5,525 |
$124K |
| D1110 |
Prophylaxis - adult |
2,187 |
1,993 |
$97K |
| D2941 |
|
959 |
273 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,984 |
3,659 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,291 |
2,057 |
$73K |
| D2140 |
|
1,259 |
798 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,328 |
3,001 |
$64K |
| D9920 |
|
1,414 |
1,207 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
844 |
584 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
604 |
412 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
667 |
412 |
$50K |
| D0330 |
Panoramic radiographic image |
879 |
830 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
505 |
355 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,767 |
1,643 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,387 |
1,096 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
342 |
220 |
$21K |
| D1352 |
|
253 |
114 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
429 |
259 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
978 |
804 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
851 |
458 |
$7K |
| D7111 |
|
72 |
54 |
$5K |
| D2940 |
|
89 |
68 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
93 |
$3K |
| D2160 |
|
16 |
13 |
$1K |
| D0240 |
|
62 |
61 |
$1K |