| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
37,286 |
7,474 |
$6.87M |
| D7140 |
Extraction, erupted tooth or exposed root |
23,487 |
7,636 |
$2.19M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,037 |
8,568 |
$1.81M |
| D1120 |
Prophylaxis - child |
34,719 |
34,295 |
$1.42M |
| D1208 |
Topical application of fluoride, excluding varnish |
56,027 |
55,118 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
42,696 |
42,184 |
$1.37M |
| D1351 |
Sealant - per tooth |
39,313 |
11,536 |
$1.28M |
| D9420 |
|
7,107 |
7,029 |
$1.19M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,607 |
3,265 |
$790K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,998 |
3,810 |
$710K |
| D1110 |
Prophylaxis - adult |
10,509 |
10,389 |
$597K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,239 |
15,282 |
$587K |
| D2140 |
|
7,904 |
4,043 |
$581K |
| D0210 |
Intraoral - complete series of radiographic images |
5,846 |
5,777 |
$574K |
| D0272 |
Bitewings - two radiographic images |
16,592 |
16,397 |
$482K |
| D0220 |
Intraoral - periapical first radiographic image |
22,688 |
21,904 |
$410K |
| D2330 |
|
3,869 |
2,299 |
$371K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,913 |
6,839 |
$335K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,051 |
1,880 |
$274K |
| D0274 |
Bitewings - four radiographic images |
6,391 |
6,312 |
$248K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,534 |
5,460 |
$193K |
| D1330 |
|
7,933 |
7,823 |
$191K |
| D1510 |
|
886 |
648 |
$152K |
| D2331 |
|
1,080 |
644 |
$127K |
| D0140 |
Limited oral evaluation - problem focused |
2,611 |
2,542 |
$122K |
| D0603 |
|
12,182 |
12,001 |
$110K |
| D7111 |
|
1,180 |
662 |
$84K |
| D0330 |
Panoramic radiographic image |
869 |
865 |
$62K |
| D2160 |
|
302 |
221 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
128 |
$31K |
| D1354 |
|
2,228 |
1,110 |
$30K |
| D0602 |
|
2,350 |
2,316 |
$20K |
| D0601 |
|
2,106 |
2,076 |
$16K |
| D2390 |
|
54 |
28 |
$14K |
| D2931 |
|
43 |
32 |
$10K |
| D2332 |
|
51 |
32 |
$9K |
| D3120 |
|
262 |
218 |
$9K |
| D1353 |
|
272 |
192 |
$7K |
| D9971 |
|
81 |
25 |
$3K |
| D0270 |
|
150 |
148 |
$3K |
| D9430 |
|
35 |
29 |
$1K |