| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,125 |
4,063 |
$1.97M |
| D1120 |
Prophylaxis - child |
40,480 |
40,464 |
$1.71M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,412 |
7,866 |
$1.67M |
| D0120 |
Periodic oral evaluation - established patient |
44,051 |
44,041 |
$1.51M |
| D1206 |
Topical application of fluoride varnish |
46,525 |
46,485 |
$1.30M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,255 |
5,748 |
$776K |
| D0272 |
Bitewings - two radiographic images |
33,409 |
33,384 |
$624K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,928 |
4,001 |
$623K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,693 |
2,219 |
$474K |
| D1351 |
Sealant - per tooth |
14,726 |
4,310 |
$431K |
| D1110 |
Prophylaxis - adult |
7,437 |
7,436 |
$403K |
| D2390 |
|
2,111 |
904 |
$395K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,923 |
5,923 |
$338K |
| D2331 |
|
3,237 |
2,058 |
$332K |
| D2330 |
|
3,724 |
2,315 |
$303K |
| D1510 |
|
863 |
704 |
$173K |
| D0240 |
|
7,015 |
4,432 |
$134K |
| D0330 |
Panoramic radiographic image |
1,498 |
1,498 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
1,733 |
1,721 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,071 |
2,224 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
3,613 |
3,582 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
384 |
$66K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,431 |
1,430 |
$60K |
| D9248 |
|
1,276 |
1,192 |
$53K |
| D2140 |
|
541 |
421 |
$41K |
| D2332 |
|
210 |
140 |
$27K |
| D1354 |
|
635 |
297 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
168 |
138 |
$16K |
| D9420 |
|
112 |
109 |
$15K |
| D7111 |
|
70 |
52 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
567 |
244 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,853 |
10,301 |
$0.00 |