| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,252 |
2,057 |
$2.00M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,643 |
2,593 |
$659K |
| D1120 |
Prophylaxis - child |
17,877 |
17,712 |
$614K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,766 |
3,747 |
$521K |
| D0120 |
Periodic oral evaluation - established patient |
18,309 |
18,180 |
$516K |
| D0272 |
Bitewings - two radiographic images |
14,976 |
14,840 |
$343K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,200 |
21,991 |
$308K |
| D1110 |
Prophylaxis - adult |
4,304 |
4,266 |
$228K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,661 |
877 |
$212K |
| D0274 |
Bitewings - four radiographic images |
5,437 |
5,380 |
$183K |
| D1351 |
Sealant - per tooth |
6,813 |
1,744 |
$176K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,952 |
1,582 |
$163K |
| D9248 |
|
1,396 |
1,378 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,233 |
4,144 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
9,147 |
8,863 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,187 |
6,562 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,515 |
3,425 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
595 |
306 |
$44K |
| D2330 |
|
549 |
201 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
2,145 |
2,109 |
$39K |
| D9420 |
|
597 |
581 |
$21K |
| D2331 |
|
37 |
26 |
$3K |
| D2920 |
|
15 |
13 |
$248.43 |
| D0603 |
|
14,451 |
14,365 |
$0.00 |
| D0602 |
|
11,459 |
11,394 |
$0.00 |
| D0601 |
|
175 |
174 |
$0.00 |