| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
45,846 |
14,449 |
$6.49M |
| D1120 |
Prophylaxis - child |
131,398 |
130,187 |
$4.48M |
| D0120 |
Periodic oral evaluation - established patient |
141,353 |
140,064 |
$3.99M |
| D1206 |
Topical application of fluoride varnish |
168,320 |
166,472 |
$3.74M |
| D7140 |
Extraction, erupted tooth or exposed root |
33,969 |
15,595 |
$2.57M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32,473 |
24,294 |
$2.55M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
48,876 |
46,319 |
$2.08M |
| D1110 |
Prophylaxis - adult |
41,608 |
41,296 |
$1.82M |
| D0274 |
Bitewings - four radiographic images |
51,497 |
50,987 |
$1.71M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22,445 |
17,745 |
$1.46M |
| D1351 |
Sealant - per tooth |
42,281 |
14,253 |
$1.42M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31,833 |
31,529 |
$900K |
| D2933 |
|
4,704 |
1,467 |
$785K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,205 |
4,178 |
$779K |
| D0210 |
Intraoral - complete series of radiographic images |
15,038 |
14,897 |
$736K |
| D0272 |
Bitewings - two radiographic images |
35,057 |
34,745 |
$723K |
| D1330 |
|
106,980 |
106,713 |
$638K |
| D0240 |
|
23,466 |
19,839 |
$501K |
| D0330 |
Panoramic radiographic image |
9,549 |
9,496 |
$458K |
| D0602 |
|
41,467 |
41,392 |
$405K |
| D0603 |
|
38,579 |
38,491 |
$374K |
| D0140 |
Limited oral evaluation - problem focused |
6,662 |
6,589 |
$271K |
| D3230 |
|
1,523 |
634 |
$262K |
| D0220 |
Intraoral - periapical first radiographic image |
20,368 |
19,858 |
$216K |
| D2934 |
|
924 |
265 |
$164K |
| D8670 |
Periodic orthodontic treatment visit |
772 |
717 |
$158K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,520 |
3,508 |
$136K |
| D2929 |
|
343 |
261 |
$131K |
| D0601 |
|
11,539 |
11,513 |
$113K |
| D1510 |
|
714 |
459 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,631 |
4,768 |
$81K |
| D2330 |
|
1,394 |
912 |
$78K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
49 |
45 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
631 |
571 |
$45K |
| D2331 |
|
658 |
458 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,619 |
1,618 |
$40K |
| D2332 |
|
375 |
276 |
$27K |
| D8660 |
|
233 |
225 |
$27K |
| D9110 |
|
726 |
715 |
$26K |
| D1517 |
|
88 |
76 |
$20K |
| D0270 |
|
1,811 |
1,794 |
$18K |
| D1354 |
|
668 |
465 |
$12K |
| D2335 |
|
154 |
125 |
$11K |
| D9920 |
|
57 |
56 |
$3K |
| D1999 |
|
12,851 |
11,666 |
$1K |
| D0170 |
|
124 |
121 |
$1K |
| D9612 |
|
43 |
43 |
$0.00 |
| D9420 |
|
27 |
27 |
$0.00 |