| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,926 |
4,203 |
$2.07M |
| D1120 |
Prophylaxis - child |
34,300 |
33,394 |
$1.26M |
| D0120 |
Periodic oral evaluation - established patient |
23,760 |
23,220 |
$642K |
| D1206 |
Topical application of fluoride varnish |
33,389 |
32,500 |
$545K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,089 |
2,710 |
$353K |
| D0603 |
|
26,221 |
25,547 |
$335K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,714 |
1,735 |
$329K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,844 |
7,151 |
$279K |
| D1351 |
Sealant - per tooth |
11,057 |
3,469 |
$255K |
| D0272 |
Bitewings - two radiographic images |
14,147 |
13,732 |
$237K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,730 |
5,501 |
$221K |
| D0240 |
|
9,676 |
5,433 |
$150K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,660 |
1,623 |
$141K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,434 |
5,954 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
11,279 |
9,923 |
$140K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,247 |
4,139 |
$126K |
| D1354 |
|
5,653 |
2,057 |
$111K |
| D0330 |
Panoramic radiographic image |
2,710 |
2,637 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
2,616 |
2,485 |
$96K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
967 |
380 |
$80K |
| D1510 |
|
350 |
234 |
$51K |
| D9310 |
|
482 |
464 |
$41K |
| D0602 |
|
2,171 |
2,136 |
$22K |
| D2933 |
|
117 |
28 |
$18K |
| D0601 |
|
1,653 |
1,599 |
$16K |
| D9248 |
|
120 |
115 |
$15K |
| D2330 |
|
107 |
49 |
$6K |
| D2332 |
|
30 |
12 |
$3K |
| D1110 |
Prophylaxis - adult |
126 |
106 |
$3K |
| D2331 |
|
30 |
17 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
53 |
$3K |
| D1999 |
|
2,767 |
2,560 |
$3K |
| D9920 |
|
44 |
39 |
$2K |
| D0274 |
Bitewings - four radiographic images |
59 |
58 |
$1K |
| D1320 |
|
282 |
275 |
$886.20 |
| D0170 |
|
13 |
13 |
$360.48 |
| D1330 |
|
25,905 |
25,390 |
$30.46 |
| D1310 |
|
25,792 |
25,283 |
$20.01 |
| D9999 |
Unspecified adjunctive procedure, by report |
43 |
42 |
$0.00 |