| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,217 |
2,342 |
$1.06M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,905 |
4,140 |
$436K |
| D1120 |
Prophylaxis - child |
16,751 |
15,271 |
$406K |
| D0120 |
Periodic oral evaluation - established patient |
14,996 |
13,633 |
$319K |
| D1206 |
Topical application of fluoride varnish |
16,028 |
14,717 |
$311K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,276 |
3,390 |
$308K |
| D1351 |
Sealant - per tooth |
9,757 |
3,306 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,654 |
1,946 |
$233K |
| D0210 |
Intraoral - complete series of radiographic images |
3,161 |
2,950 |
$223K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,806 |
5,836 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,438 |
5,044 |
$166K |
| D2335 |
|
1,374 |
506 |
$132K |
| D0272 |
Bitewings - two radiographic images |
8,503 |
7,751 |
$100K |
| D1110 |
Prophylaxis - adult |
2,123 |
1,969 |
$84K |
| D0240 |
|
6,155 |
2,555 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,958 |
2,611 |
$37K |
| D0330 |
Panoramic radiographic image |
670 |
605 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,079 |
1,008 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
465 |
293 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
719 |
669 |
$18K |
| D2140 |
|
372 |
223 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
151 |
84 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
116 |
103 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,309 |
1,189 |
$6K |
| D2330 |
|
39 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
358 |
311 |
$2K |
| D2160 |
|
17 |
16 |
$1K |
| D1354 |
|
60 |
38 |
$914.25 |