| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,192 |
2,104 |
$1.43M |
| D1120 |
Prophylaxis - child |
16,646 |
16,445 |
$599K |
| D0120 |
Periodic oral evaluation - established patient |
13,616 |
13,472 |
$498K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,091 |
1,897 |
$464K |
| D1206 |
Topical application of fluoride varnish |
16,720 |
16,512 |
$421K |
| D0140 |
Limited oral evaluation - problem focused |
3,773 |
3,674 |
$179K |
| D0272 |
Bitewings - two radiographic images |
5,791 |
5,730 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,190 |
1,405 |
$168K |
| D1351 |
Sealant - per tooth |
5,625 |
1,884 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,695 |
2,652 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,543 |
1,063 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,476 |
4,234 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
2,905 |
2,827 |
$55K |
| D0240 |
|
2,096 |
1,455 |
$51K |
| D0330 |
Panoramic radiographic image |
584 |
580 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,370 |
1,215 |
$49K |
| D2335 |
|
371 |
162 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
230 |
228 |
$28K |
| D9420 |
|
1,142 |
1,126 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
159 |
97 |
$13K |
| D2330 |
|
175 |
116 |
$12K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
259 |
247 |
$11K |
| D1510 |
|
61 |
37 |
$9K |
| D1110 |
Prophylaxis - adult |
136 |
136 |
$6K |
| D1330 |
|
91 |
91 |
$2K |
| D9248 |
|
83 |
81 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
45 |
$2K |
| D1354 |
|
60 |
25 |
$1K |
| D2331 |
|
13 |
12 |
$1K |
| D0270 |
|
12 |
12 |
$216.12 |