| Code | Description | Total Paid |
|---|---|---|
| D5120 | $2.32M | |
| D0120 | Periodic oral evaluation - established patient | $1.78M |
| D1120 | Prophylaxis - child | $1.52M |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | $967K |
| D5110 | $701K | |
| D2930 | Prefabricated stainless steel crown - primary tooth | $635K |
| D1208 | Topical application of fluoride, excluding varnish | $542K |
| D1310 | $541K | |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | $493K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | $474K |
| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | CHILDRENS HAPPY TEETH | LA MIRADA, CA | 325,917 | $9.72M |
| 2 | DENTURE CLINIC INC | IDAHO FALLS, ID | 7,402 | $3.05M |
| 3 | ELENES DENTAL CORPORATION | SAN BERNARDINO, CA | 38,728 | $1.00M |
| 4 | MOYNIHAN DENTAL SPECIALISTS LLC | NORTHBOROUGH, MA | 10,961 | $394K |
| 5 | ELENES DENTAL CORPORATION | LYNWOOD, CA | 13,451 | $256K |
| 6 | UCLA ORAL PATHOLOGY | LOS ANGELES, CA | 4,878 | $211K |
| 7 | GREEN DENTAL LAB, INC. | HEBER SPRINGS, AR | 1,318 | $211K |
| 8 | ROGUE RIVER DENTURE SERVICE | GRANTS PASS, OR | 55 | $26K |
| 9 | CORNISH DENTURE CENTER, LLC | CORNISH, ME | 199 | $10K |
| 10 | JOHN P. MARCONNIT D.D.S., P.C. | LEWISTON, MI | 155 | $4K |