| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,611 |
2,069 |
$1.69M |
| D1120 |
Prophylaxis - child |
24,023 |
23,100 |
$1.30M |
| D0120 |
Periodic oral evaluation - established patient |
20,938 |
20,280 |
$873K |
| D1206 |
Topical application of fluoride varnish |
25,011 |
24,061 |
$804K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,648 |
2,109 |
$744K |
| D1351 |
Sealant - per tooth |
17,144 |
3,267 |
$701K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,494 |
1,801 |
$585K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,354 |
1,750 |
$429K |
| D0272 |
Bitewings - two radiographic images |
11,797 |
11,309 |
$429K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,779 |
4,451 |
$347K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,689 |
4,358 |
$316K |
| D0330 |
Panoramic radiographic image |
3,252 |
3,088 |
$283K |
| D1354 |
|
4,254 |
1,144 |
$245K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,785 |
3,663 |
$219K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
934 |
443 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
6,414 |
5,936 |
$152K |
| D0140 |
Limited oral evaluation - problem focused |
2,155 |
2,027 |
$128K |
| D1110 |
Prophylaxis - adult |
1,619 |
1,572 |
$118K |
| D0274 |
Bitewings - four radiographic images |
2,062 |
1,990 |
$107K |
| D0160 |
|
756 |
652 |
$80K |
| D0240 |
|
1,373 |
1,028 |
$36K |
| D9920 |
|
14 |
14 |
$2K |
| D0602 |
|
2,528 |
2,450 |
$0.00 |
| D0603 |
|
24,065 |
23,059 |
$0.00 |
| D9420 |
|
769 |
671 |
$0.00 |
| D0431 |
|
310 |
309 |
$0.00 |
| D9986 |
|
125 |
125 |
$0.00 |