| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,344 |
3,195 |
$1.22M |
| D1120 |
Prophylaxis - child |
25,042 |
24,382 |
$799K |
| D0120 |
Periodic oral evaluation - established patient |
26,224 |
25,593 |
$611K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,174 |
4,040 |
$493K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,016 |
3,137 |
$410K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,378 |
19,857 |
$394K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,542 |
3,779 |
$368K |
| D1110 |
Prophylaxis - adult |
7,287 |
7,121 |
$295K |
| D1351 |
Sealant - per tooth |
11,303 |
3,607 |
$286K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,506 |
8,531 |
$269K |
| D0210 |
Intraoral - complete series of radiographic images |
4,792 |
4,699 |
$239K |
| D1206 |
Topical application of fluoride varnish |
10,976 |
10,681 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,461 |
13,188 |
$196K |
| D0220 |
Intraoral - periapical first radiographic image |
15,470 |
14,921 |
$185K |
| D0272 |
Bitewings - two radiographic images |
10,641 |
10,356 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,912 |
5,704 |
$156K |
| D0274 |
Bitewings - four radiographic images |
6,217 |
6,023 |
$131K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,206 |
651 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
629 |
421 |
$49K |
| D0330 |
Panoramic radiographic image |
1,870 |
1,814 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
2,190 |
2,116 |
$47K |
| D8670 |
Periodic orthodontic treatment visit |
757 |
676 |
$38K |
| D2934 |
|
189 |
66 |
$23K |
| D2330 |
|
395 |
261 |
$20K |
| D9248 |
|
147 |
137 |
$12K |
| D1515 |
|
57 |
48 |
$11K |
| D1354 |
|
1,240 |
454 |
$9K |
| D1353 |
|
230 |
92 |
$6K |
| D2331 |
|
64 |
41 |
$4K |
| D9243 |
|
39 |
15 |
$3K |
| D1510 |
|
18 |
17 |
$3K |
| D8660 |
|
44 |
37 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
58 |
58 |
$1K |
| D9239 |
|
15 |
15 |
$1K |
| D3120 |
|
51 |
28 |
$39.14 |
| D0270 |
|
12 |
12 |
$23.40 |