| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92,640 |
43,026 |
$15.05M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148,776 |
104,581 |
$14.38M |
| D1120 |
Prophylaxis - child |
403,602 |
399,440 |
$12.55M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111,212 |
82,349 |
$8.73M |
| D0120 |
Periodic oral evaluation - established patient |
384,896 |
381,022 |
$8.67M |
| D1351 |
Sealant - per tooth |
237,395 |
93,823 |
$7.85M |
| D1208 |
Topical application of fluoride, excluding varnish |
455,947 |
451,677 |
$7.44M |
| D0274 |
Bitewings - four radiographic images |
184,354 |
182,200 |
$6.02M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166,872 |
164,580 |
$5.73M |
| D0272 |
Bitewings - two radiographic images |
252,180 |
249,457 |
$5.31M |
| D1110 |
Prophylaxis - adult |
133,624 |
131,965 |
$4.15M |
| D0220 |
Intraoral - periapical first radiographic image |
234,732 |
231,380 |
$3.07M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24,321 |
18,804 |
$3.02M |
| D0330 |
Panoramic radiographic image |
79,413 |
78,311 |
$2.80M |
| D7140 |
Extraction, erupted tooth or exposed root |
34,761 |
23,348 |
$2.45M |
| D7240 |
Removal of impacted tooth - completely bony |
9,165 |
4,003 |
$2.39M |
| D0210 |
Intraoral - complete series of radiographic images |
57,119 |
56,878 |
$2.34M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21,457 |
10,268 |
$2.06M |
| D2934 |
|
14,032 |
4,913 |
$2.01M |
| D0230 |
Intraoral - periapical each additional radiographic image |
178,966 |
174,773 |
$1.80M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49,484 |
46,979 |
$1.07M |
| D0140 |
Limited oral evaluation - problem focused |
37,235 |
36,426 |
$1.07M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,551 |
5,142 |
$940K |
| D7230 |
|
3,227 |
2,113 |
$644K |
| D1510 |
|
2,413 |
1,728 |
$404K |
| D1206 |
Topical application of fluoride varnish |
21,426 |
20,793 |
$342K |
| D7111 |
|
6,169 |
4,522 |
$301K |
| D2330 |
|
3,264 |
2,266 |
$241K |
| D9630 |
|
7,106 |
7,008 |
$204K |
| D9920 |
|
4,562 |
4,270 |
$197K |
| D0603 |
|
14,520 |
14,481 |
$142K |
| D9999 |
Unspecified adjunctive procedure, by report |
273 |
273 |
$113K |
| D9410 |
|
310 |
306 |
$107K |
| D0602 |
|
7,728 |
7,706 |
$72K |
| D0240 |
|
3,914 |
2,898 |
$54K |
| D7220 |
|
202 |
135 |
$30K |
| D2331 |
|
288 |
224 |
$24K |
| D0601 |
|
1,168 |
1,167 |
$7K |
| D0270 |
|
809 |
793 |
$7K |
| D2335 |
|
28 |
24 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
64 |
52 |
$4K |
| D2394 |
|
22 |
18 |
$4K |
| D9222 |
|
78 |
66 |
$3K |
| D1517 |
|
12 |
12 |
$3K |
| D7250 |
|
23 |
13 |
$2K |
| D2991 |
|
55 |
15 |
$2K |
| D1999 |
|
45,866 |
42,521 |
$493.22 |
| D0350 |
|
888 |
839 |
$224.33 |
| D3120 |
|
59 |
51 |
$70.00 |
| D4355 |
|
12 |
12 |
$0.00 |