| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,783 |
1,003 |
$825K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,096 |
2,305 |
$500K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,158 |
2,112 |
$497K |
| D1351 |
Sealant - per tooth |
19,985 |
3,242 |
$441K |
| D1120 |
Prophylaxis - child |
21,646 |
14,984 |
$437K |
| D1206 |
Topical application of fluoride varnish |
15,065 |
10,792 |
$278K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,743 |
9,161 |
$271K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,806 |
7,006 |
$220K |
| D0210 |
Intraoral - complete series of radiographic images |
4,559 |
3,357 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
7,294 |
5,886 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,459 |
1,023 |
$150K |
| D0140 |
Limited oral evaluation - problem focused |
4,526 |
3,411 |
$144K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,505 |
3,190 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
10,486 |
7,557 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,608 |
4,238 |
$58K |
| D0272 |
Bitewings - two radiographic images |
5,098 |
3,722 |
$58K |
| D0330 |
Panoramic radiographic image |
2,766 |
2,141 |
$53K |
| D0274 |
Bitewings - four radiographic images |
3,095 |
2,064 |
$48K |
| D1516 |
|
124 |
119 |
$29K |
| D1515 |
|
139 |
54 |
$19K |
| D1517 |
|
59 |
54 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
189 |
79 |
$11K |
| D9310 |
|
193 |
98 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
126 |
96 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
12 |
$3K |
| D1110 |
Prophylaxis - adult |
278 |
265 |
$2K |
| D1999 |
|
93 |
92 |
$0.00 |
| D1310 |
|
909 |
457 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
66 |
65 |
$0.00 |
| D1330 |
|
153 |
152 |
$0.00 |