| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,860 |
8,538 |
$3.36M |
| D0120 |
Periodic oral evaluation - established patient |
81,614 |
79,415 |
$2.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,609 |
12,200 |
$2.07M |
| D1120 |
Prophylaxis - child |
72,039 |
70,721 |
$1.97M |
| D1351 |
Sealant - per tooth |
55,423 |
13,980 |
$1.54M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,399 |
11,375 |
$1.53M |
| D1208 |
Topical application of fluoride, excluding varnish |
89,663 |
87,958 |
$1.49M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25,907 |
24,554 |
$1.13M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,585 |
8,822 |
$982K |
| D1110 |
Prophylaxis - adult |
22,809 |
22,212 |
$869K |
| D0240 |
|
37,300 |
20,093 |
$596K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,046 |
11,714 |
$537K |
| D0272 |
Bitewings - two radiographic images |
29,044 |
28,466 |
$530K |
| D0330 |
Panoramic radiographic image |
9,043 |
8,838 |
$487K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,121 |
10,815 |
$368K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,571 |
2,282 |
$362K |
| D0274 |
Bitewings - four radiographic images |
11,017 |
10,742 |
$351K |
| D0220 |
Intraoral - periapical first radiographic image |
21,670 |
20,825 |
$322K |
| D2934 |
|
1,661 |
523 |
$304K |
| D9420 |
|
2,144 |
2,045 |
$243K |
| D0140 |
Limited oral evaluation - problem focused |
6,006 |
5,789 |
$220K |
| D1510 |
|
1,043 |
789 |
$194K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,027 |
3,942 |
$146K |
| D2332 |
|
1,382 |
727 |
$128K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
836 |
664 |
$109K |
| D1206 |
Topical application of fluoride varnish |
4,049 |
3,950 |
$65K |
| D2331 |
|
296 |
206 |
$24K |
| D0170 |
|
584 |
568 |
$17K |
| D1354 |
|
1,913 |
869 |
$14K |
| D2390 |
|
31 |
12 |
$5K |
| D2330 |
|
59 |
36 |
$4K |
| D9440 |
|
40 |
36 |
$2K |