| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,278 |
5,680 |
$1.63M |
| D1351 |
Sealant - per tooth |
53,607 |
16,849 |
$1.35M |
| D1206 |
Topical application of fluoride varnish |
63,868 |
60,692 |
$1.27M |
| D1120 |
Prophylaxis - child |
38,355 |
36,443 |
$1.18M |
| D0120 |
Periodic oral evaluation - established patient |
56,176 |
53,383 |
$1.15M |
| D1110 |
Prophylaxis - adult |
25,344 |
24,079 |
$1.12M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
11,191 |
6,939 |
$743K |
| D2140 |
|
13,985 |
9,377 |
$726K |
| D0274 |
Bitewings - four radiographic images |
22,486 |
21,311 |
$664K |
| D0272 |
Bitewings - two radiographic images |
27,762 |
26,381 |
$582K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,157 |
13,676 |
$389K |
| D2160 |
|
2,971 |
1,977 |
$236K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,094 |
6,714 |
$222K |
| D0210 |
Intraoral - complete series of radiographic images |
7,005 |
5,147 |
$217K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,994 |
2,086 |
$215K |
| D1354 |
|
2,638 |
902 |
$205K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,316 |
939 |
$104K |
| D0240 |
|
6,537 |
5,662 |
$103K |
| D2331 |
|
928 |
654 |
$74K |
| D0330 |
Panoramic radiographic image |
2,067 |
1,940 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,873 |
5,452 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,466 |
1,346 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,466 |
2,908 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,097 |
1,023 |
$35K |
| D7111 |
|
488 |
337 |
$34K |
| D2330 |
|
332 |
245 |
$25K |
| D1510 |
|
81 |
79 |
$15K |
| D4346 |
|
55 |
45 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
52 |
$9K |
| D0270 |
|
115 |
111 |
$2K |
| D2920 |
|
31 |
29 |
$2K |
| D0603 |
|
45,097 |
42,772 |
$0.00 |
| D0602 |
|
8,329 |
7,871 |
$0.00 |
| D1330 |
|
114 |
102 |
$0.00 |
| D1310 |
|
114 |
102 |
$0.00 |
| D0350 |
|
258 |
227 |
$0.00 |