| Code | Description | Total Paid |
|---|---|---|
| D0120 | Periodic oral evaluation - established patient | $1.34M |
| D1120 | Prophylaxis - child | $1.29M |
| D1206 | Topical application of fluoride varnish | $512K |
| D2930 | Prefabricated stainless steel crown - primary tooth | $509K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | $422K |
| D0230 | Intraoral - periapical each additional radiographic image | $419K |
| D1310 | $333K | |
| D7111 | $263K | |
| D1351 | Sealant - per tooth | $245K |
| D0274 | Bitewings - four radiographic images | $243K |
| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | CHILDREN'S DENTAL FOUNDATION | LONG BEACH, CA | 200,875 | $7.09M |
| 2 | ROCKY MOUNTAIN YOUTH MEDICAL AND NURSING CONSULTANTS, INC | AURORA, CO | 13,193 | $344K |
| 3 | NORTH MIAMI BEACH DENTAL | NORTH MIAMI BEACH, FL | 9,742 | $185K |
| 4 | CASCADE FAMILY DENTISTRY PLLC | GREAT FALLS, MT | 3,822 | $122K |