| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,639 |
2,306 |
$1.31M |
| D1120 |
Prophylaxis - child |
13,225 |
12,498 |
$347K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,461 |
1,772 |
$344K |
| D0120 |
Periodic oral evaluation - established patient |
11,005 |
10,433 |
$276K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,648 |
1,775 |
$276K |
| D1206 |
Topical application of fluoride varnish |
14,105 |
13,327 |
$220K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,718 |
1,479 |
$205K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,194 |
3,588 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,717 |
3,455 |
$159K |
| D2390 |
|
1,138 |
305 |
$138K |
| D1351 |
Sealant - per tooth |
5,003 |
1,559 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,905 |
3,366 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
2,675 |
2,440 |
$97K |
| D0272 |
Bitewings - two radiographic images |
4,901 |
4,585 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
5,619 |
5,025 |
$80K |
| D0330 |
Panoramic radiographic image |
1,205 |
1,129 |
$65K |
| D1110 |
Prophylaxis - adult |
1,292 |
1,229 |
$47K |
| D9420 |
|
359 |
289 |
$35K |
| D2330 |
|
556 |
264 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
347 |
188 |
$27K |
| D1510 |
|
133 |
87 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
784 |
605 |
$22K |
| D9110 |
|
277 |
246 |
$11K |
| D0274 |
Bitewings - four radiographic images |
169 |
146 |
$4K |
| D1354 |
|
224 |
98 |
$907.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
45 |
$799.04 |
| D3120 |
|
315 |
148 |
$0.00 |
| D1330 |
|
79 |
70 |
$0.00 |