| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,753 |
1,883 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
44,822 |
43,924 |
$1.14M |
| D1110 |
Prophylaxis - adult |
18,063 |
17,721 |
$832K |
| D1120 |
Prophylaxis - child |
23,337 |
22,858 |
$793K |
| D1208 |
Topical application of fluoride, excluding varnish |
41,121 |
40,280 |
$747K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,415 |
3,177 |
$581K |
| D0240 |
|
18,339 |
17,937 |
$432K |
| D0272 |
Bitewings - two radiographic images |
15,640 |
15,362 |
$370K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,208 |
3,098 |
$288K |
| D2140 |
|
4,628 |
2,801 |
$272K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,395 |
2,235 |
$243K |
| D1351 |
Sealant - per tooth |
7,521 |
1,945 |
$187K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,345 |
8,021 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,972 |
1,242 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,507 |
1,002 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
3,038 |
2,937 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
850 |
768 |
$63K |
| D2330 |
|
627 |
393 |
$42K |
| D0330 |
Panoramic radiographic image |
601 |
546 |
$32K |
| D9248 |
|
307 |
299 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,068 |
1,026 |
$18K |
| D2331 |
|
18 |
12 |
$2K |