| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,444 |
2,142 |
$739K |
| D9248 |
|
5,768 |
5,114 |
$531K |
| D1120 |
Prophylaxis - child |
6,905 |
6,768 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
7,885 |
7,701 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,696 |
1,552 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,164 |
5,497 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
9,487 |
9,063 |
$149K |
| D0272 |
Bitewings - two radiographic images |
6,685 |
6,563 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,282 |
6,128 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
1,593 |
1,459 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,576 |
7,375 |
$93K |
| D2140 |
|
1,450 |
861 |
$93K |
| D1110 |
Prophylaxis - adult |
1,878 |
1,828 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,191 |
723 |
$73K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
905 |
671 |
$71K |
| D1351 |
Sealant - per tooth |
2,688 |
885 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
700 |
529 |
$53K |
| D1510 |
|
302 |
255 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,500 |
1,429 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,253 |
2,225 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
498 |
292 |
$42K |
| D0603 |
|
8,598 |
8,386 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
880 |
$28K |
| D2934 |
|
87 |
36 |
$12K |
| D7111 |
|
183 |
109 |
$8K |
| D0330 |
Panoramic radiographic image |
692 |
677 |
$6K |
| D2330 |
|
72 |
40 |
$5K |
| D1354 |
|
27 |
13 |
$375.00 |