| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,988 |
1,894 |
$1.13M |
| D1120 |
Prophylaxis - child |
11,986 |
11,930 |
$333K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,172 |
12,788 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
10,921 |
10,880 |
$261K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,779 |
1,008 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,985 |
1,736 |
$185K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,717 |
1,261 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,056 |
1,189 |
$161K |
| D9420 |
|
1,599 |
1,591 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,468 |
3,156 |
$104K |
| D0272 |
Bitewings - two radiographic images |
7,129 |
7,106 |
$98K |
| D1999 |
|
7,873 |
7,118 |
$78K |
| D1351 |
Sealant - per tooth |
2,410 |
869 |
$64K |
| D1110 |
Prophylaxis - adult |
1,632 |
1,624 |
$58K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,183 |
1,180 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,994 |
1,990 |
$47K |
| D0330 |
Panoramic radiographic image |
1,371 |
1,367 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,044 |
1,926 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
4,357 |
4,037 |
$27K |
| D0240 |
|
2,094 |
1,792 |
$15K |
| D2934 |
|
79 |
26 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
231 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
59 |
$3K |
| D7111 |
|
42 |
24 |
$2K |
| D2140 |
|
27 |
12 |
$1K |