| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,928 |
1,474 |
$571K |
| D1120 |
Prophylaxis - child |
22,761 |
21,934 |
$519K |
| D1206 |
Topical application of fluoride varnish |
26,577 |
25,628 |
$455K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,529 |
4,029 |
$389K |
| D0120 |
Periodic oral evaluation - established patient |
17,125 |
16,554 |
$340K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,520 |
8,150 |
$246K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,495 |
1,988 |
$229K |
| D0272 |
Bitewings - two radiographic images |
18,795 |
18,069 |
$213K |
| D1351 |
Sealant - per tooth |
7,117 |
1,896 |
$183K |
| D1110 |
Prophylaxis - adult |
4,417 |
4,277 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,709 |
1,889 |
$155K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,018 |
3,732 |
$143K |
| D1354 |
|
5,202 |
1,925 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,915 |
3,794 |
$83K |
| D0330 |
Panoramic radiographic image |
920 |
871 |
$54K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
612 |
315 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,318 |
1,262 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
522 |
310 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
417 |
293 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,876 |
3,743 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,197 |
1,098 |
$7K |
| D2160 |
|
76 |
67 |
$5K |
| D2140 |
|
22 |
18 |
$840.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
52 |
$825.00 |
| D2330 |
|
15 |
13 |
$768.15 |
| D0240 |
|
58 |
32 |
$624.00 |