| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,224 |
5,288 |
$1.61M |
| D1351 |
Sealant - per tooth |
47,236 |
13,153 |
$1.17M |
| D1206 |
Topical application of fluoride varnish |
53,995 |
51,216 |
$1.05M |
| D1110 |
Prophylaxis - adult |
23,142 |
21,951 |
$985K |
| D1120 |
Prophylaxis - child |
31,868 |
30,202 |
$971K |
| D0120 |
Periodic oral evaluation - established patient |
47,253 |
44,870 |
$950K |
| D2140 |
|
12,443 |
8,481 |
$654K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,664 |
6,056 |
$634K |
| D0274 |
Bitewings - four radiographic images |
19,939 |
18,885 |
$575K |
| D0272 |
Bitewings - two radiographic images |
24,286 |
22,988 |
$499K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,597 |
10,036 |
$277K |
| D0210 |
Intraoral - complete series of radiographic images |
7,289 |
5,731 |
$242K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,407 |
6,961 |
$240K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,010 |
2,021 |
$222K |
| D2160 |
|
2,616 |
1,862 |
$198K |
| D1354 |
|
2,090 |
677 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,147 |
811 |
$90K |
| D0240 |
|
5,047 |
3,487 |
$76K |
| D0330 |
Panoramic radiographic image |
2,284 |
2,072 |
$71K |
| D2331 |
|
670 |
476 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
5,071 |
4,667 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,377 |
1,292 |
$42K |
| D7111 |
|
459 |
326 |
$28K |
| D2330 |
|
365 |
296 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,358 |
1,854 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
168 |
133 |
$18K |
| D2934 |
|
83 |
25 |
$13K |
| D2332 |
|
96 |
70 |
$10K |
| D1510 |
|
49 |
44 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
173 |
157 |
$5K |
| D0270 |
|
206 |
202 |
$3K |
| D0350 |
|
180 |
163 |
$0.00 |
| D0603 |
|
40,152 |
38,143 |
$0.00 |
| D0601 |
|
1,440 |
1,370 |
$0.00 |
| D0602 |
|
8,301 |
7,881 |
$0.00 |
| 15200 |
|
68 |
59 |
$0.00 |
| D1310 |
|
1,627 |
1,478 |
$0.00 |