| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,318 |
2,022 |
$1.19M |
| D1120 |
Prophylaxis - child |
21,900 |
21,099 |
$621K |
| D0120 |
Periodic oral evaluation - established patient |
30,212 |
29,058 |
$574K |
| D1110 |
Prophylaxis - adult |
8,978 |
8,611 |
$333K |
| D1206 |
Topical application of fluoride varnish |
13,962 |
13,432 |
$324K |
| D0330 |
Panoramic radiographic image |
5,582 |
5,369 |
$276K |
| D1999 |
|
19,835 |
18,561 |
$273K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,745 |
17,032 |
$258K |
| D0272 |
Bitewings - two radiographic images |
13,799 |
13,279 |
$249K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,104 |
1,815 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,506 |
1,629 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,559 |
1,291 |
$168K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,640 |
6,042 |
$144K |
| D0274 |
Bitewings - four radiographic images |
5,904 |
5,641 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
3,876 |
3,616 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,498 |
2,774 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
7,373 |
6,772 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
810 |
344 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,100 |
1,047 |
$27K |
| D1351 |
Sealant - per tooth |
1,144 |
304 |
$25K |
| D9110 |
|
108 |
104 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
68 |
$3K |
| D0240 |
|
113 |
52 |
$1K |
| D1354 |
|
66 |
27 |
$610.00 |
| D9420 |
|
1,832 |
1,694 |
$0.00 |