| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25,488 |
7,169 |
$2.74M |
| D1120 |
Prophylaxis - child |
82,698 |
78,874 |
$2.63M |
| D0120 |
Periodic oral evaluation - established patient |
92,668 |
88,494 |
$2.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26,929 |
12,929 |
$1.87M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26,042 |
12,548 |
$1.50M |
| D1206 |
Topical application of fluoride varnish |
60,327 |
57,875 |
$1.23M |
| D1110 |
Prophylaxis - adult |
27,556 |
26,490 |
$1.14M |
| D1208 |
Topical application of fluoride, excluding varnish |
48,510 |
46,139 |
$943K |
| D7140 |
Extraction, erupted tooth or exposed root |
15,786 |
8,337 |
$904K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26,555 |
24,182 |
$732K |
| D9248 |
|
8,921 |
8,342 |
$709K |
| D0272 |
Bitewings - two radiographic images |
41,387 |
39,281 |
$674K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18,686 |
17,814 |
$519K |
| D1351 |
Sealant - per tooth |
18,608 |
5,474 |
$517K |
| D0210 |
Intraoral - complete series of radiographic images |
7,844 |
7,473 |
$449K |
| D2929 |
|
3,902 |
1,014 |
$433K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,991 |
2,382 |
$386K |
| D0330 |
Panoramic radiographic image |
7,247 |
7,064 |
$308K |
| D0274 |
Bitewings - four radiographic images |
9,676 |
9,293 |
$244K |
| D2932 |
|
1,740 |
454 |
$244K |
| D0220 |
Intraoral - periapical first radiographic image |
19,851 |
18,402 |
$226K |
| D1510 |
|
1,302 |
942 |
$189K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,927 |
6,418 |
$158K |
| D0140 |
Limited oral evaluation - problem focused |
4,900 |
4,691 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,006 |
756 |
$85K |
| D2330 |
|
1,290 |
777 |
$72K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,521 |
3,338 |
$72K |
| D2750 |
|
73 |
56 |
$37K |
| D2950 |
|
292 |
236 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$9K |
| D9110 |
|
135 |
129 |
$6K |
| D2331 |
|
75 |
53 |
$5K |
| D2335 |
|
42 |
25 |
$4K |
| D2940 |
|
73 |
59 |
$3K |
| D2920 |
|
21 |
13 |
$655.84 |