| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,347 |
2,502 |
$1.08M |
| D1354 |
|
13,098 |
2,534 |
$977K |
| D1120 |
Prophylaxis - child |
23,872 |
21,144 |
$684K |
| D1206 |
Topical application of fluoride varnish |
31,260 |
27,789 |
$579K |
| D1351 |
Sealant - per tooth |
23,663 |
4,434 |
$558K |
| D0120 |
Periodic oral evaluation - established patient |
27,692 |
24,571 |
$527K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,749 |
2,431 |
$346K |
| D1110 |
Prophylaxis - adult |
8,646 |
7,631 |
$343K |
| D2390 |
|
2,089 |
735 |
$235K |
| D0330 |
Panoramic radiographic image |
4,101 |
3,574 |
$199K |
| D0272 |
Bitewings - two radiographic images |
9,268 |
8,180 |
$185K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,127 |
6,205 |
$171K |
| D1355 |
|
1,778 |
381 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,627 |
6,329 |
$132K |
| D0274 |
Bitewings - four radiographic images |
4,346 |
3,862 |
$126K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,276 |
1,094 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
3,852 |
3,305 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,197 |
2,713 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
7,439 |
6,622 |
$83K |
| D0240 |
|
4,169 |
1,903 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
868 |
433 |
$55K |
| D9920 |
|
1,366 |
1,175 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,064 |
996 |
$34K |
| D2140 |
|
1,011 |
479 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
374 |
180 |
$18K |
| D1352 |
|
532 |
126 |
$18K |
| D1510 |
|
34 |
25 |
$5K |
| D1999 |
|
403 |
317 |
$5K |
| D2330 |
|
67 |
38 |
$3K |
| D2332 |
|
23 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
16 |
$2K |
| D2160 |
|
19 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
520 |
341 |
$895.60 |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
51 |
$725.23 |