| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,472 |
6,015 |
$1.88M |
| D1120 |
Prophylaxis - child |
40,589 |
40,547 |
$1.29M |
| D0120 |
Periodic oral evaluation - established patient |
36,082 |
36,041 |
$820K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,791 |
4,957 |
$681K |
| D1206 |
Topical application of fluoride varnish |
33,384 |
33,344 |
$620K |
| D0272 |
Bitewings - two radiographic images |
25,197 |
25,158 |
$512K |
| D2929 |
|
3,987 |
1,224 |
$462K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,052 |
3,824 |
$452K |
| D1351 |
Sealant - per tooth |
15,526 |
5,033 |
$363K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,471 |
1,782 |
$346K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,366 |
3,784 |
$340K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,183 |
10,454 |
$306K |
| D9420 |
|
3,819 |
3,817 |
$283K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,173 |
5,170 |
$182K |
| D0140 |
Limited oral evaluation - problem focused |
5,615 |
5,565 |
$165K |
| D0330 |
Panoramic radiographic image |
3,122 |
3,117 |
$149K |
| D0220 |
Intraoral - periapical first radiographic image |
12,127 |
11,993 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,295 |
7,293 |
$128K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,255 |
8,151 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,518 |
1,517 |
$45K |
| D9920 |
|
199 |
195 |
$20K |
| D2330 |
|
156 |
105 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
118 |
111 |
$4K |
| D2331 |
|
37 |
24 |
$3K |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$1K |