| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22,941 |
6,007 |
$3.29M |
| D1120 |
Prophylaxis - child |
44,860 |
41,064 |
$1.15M |
| D1351 |
Sealant - per tooth |
49,450 |
11,266 |
$1.00M |
| D1206 |
Topical application of fluoride varnish |
46,557 |
42,683 |
$717K |
| D0120 |
Periodic oral evaluation - established patient |
37,859 |
34,525 |
$706K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,039 |
13,337 |
$669K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,087 |
4,305 |
$617K |
| D0272 |
Bitewings - two radiographic images |
30,527 |
28,149 |
$492K |
| D0240 |
|
12,917 |
10,305 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,441 |
5,985 |
$186K |
| D0210 |
Intraoral - complete series of radiographic images |
3,471 |
3,053 |
$183K |
| D9420 |
|
610 |
593 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
8,896 |
8,153 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
880 |
403 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,834 |
4,418 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,394 |
1,263 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
221 |
$21K |
| D1510 |
|
109 |
61 |
$13K |
| D7961 |
|
28 |
26 |
$6K |
| D0330 |
Panoramic radiographic image |
48 |
45 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
15 |
12 |
$301.92 |