| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,039 |
4,372 |
$2.35M |
| D1120 |
Prophylaxis - child |
35,843 |
35,532 |
$1.74M |
| D1206 |
Topical application of fluoride varnish |
39,249 |
38,902 |
$979K |
| D0120 |
Periodic oral evaluation - established patient |
32,557 |
32,272 |
$903K |
| D0272 |
Bitewings - two radiographic images |
27,487 |
27,238 |
$787K |
| D8670 |
Periodic orthodontic treatment visit |
3,034 |
2,913 |
$729K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,446 |
4,739 |
$639K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,866 |
4,176 |
$626K |
| D1351 |
Sealant - per tooth |
16,313 |
5,951 |
$616K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,924 |
2,750 |
$598K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,428 |
4,230 |
$564K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,707 |
3,523 |
$546K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,555 |
6,492 |
$367K |
| D0140 |
Limited oral evaluation - problem focused |
7,771 |
7,622 |
$349K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,655 |
15,169 |
$320K |
| D1110 |
Prophylaxis - adult |
4,513 |
4,473 |
$297K |
| D0220 |
Intraoral - periapical first radiographic image |
11,432 |
11,208 |
$216K |
| D2330 |
|
1,519 |
811 |
$130K |
| D0330 |
Panoramic radiographic image |
2,236 |
2,195 |
$130K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
68 |
66 |
$77K |
| D2140 |
|
855 |
562 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,678 |
2,329 |
$58K |
| D2331 |
|
403 |
244 |
$40K |
| D7111 |
|
363 |
270 |
$27K |
| D8690 |
|
180 |
179 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
816 |
811 |
$21K |
| D8660 |
|
716 |
673 |
$20K |
| D1510 |
|
83 |
63 |
$17K |
| D2332 |
|
144 |
92 |
$17K |
| D2335 |
|
61 |
37 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
56 |
$9K |
| D8680 |
|
103 |
100 |
$9K |
| D0274 |
Bitewings - four radiographic images |
209 |
209 |
$9K |
| D2932 |
|
37 |
13 |
$8K |
| D1354 |
|
539 |
150 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
189 |
188 |
$5K |
| D7962 |
|
12 |
12 |
$4K |
| D2160 |
|
26 |
24 |
$3K |
| D3120 |
|
74 |
59 |
$3K |
| D0270 |
|
25 |
25 |
$391.00 |
| D9410 |
|
1,091 |
1,032 |
$180.00 |
| D1999 |
|
195 |
173 |
$0.00 |