| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,974 |
3,767 |
$1.96M |
| D0120 |
Periodic oral evaluation - established patient |
35,082 |
32,753 |
$892K |
| D1120 |
Prophylaxis - child |
21,981 |
20,469 |
$738K |
| D1110 |
Prophylaxis - adult |
14,075 |
13,265 |
$648K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,426 |
4,083 |
$556K |
| D0272 |
Bitewings - two radiographic images |
25,145 |
23,432 |
$526K |
| D1206 |
Topical application of fluoride varnish |
24,141 |
22,360 |
$460K |
| D0210 |
Intraoral - complete series of radiographic images |
5,455 |
5,152 |
$431K |
| D1351 |
Sealant - per tooth |
15,285 |
4,365 |
$405K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,088 |
3,216 |
$390K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,219 |
1,704 |
$340K |
| D2140 |
|
4,948 |
2,999 |
$303K |
| D9248 |
|
3,317 |
2,802 |
$278K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,720 |
10,518 |
$276K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
448 |
406 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,046 |
10,520 |
$213K |
| D0220 |
Intraoral - periapical first radiographic image |
12,154 |
10,538 |
$194K |
| D8670 |
Periodic orthodontic treatment visit |
1,614 |
1,450 |
$173K |
| D0603 |
|
35,110 |
32,748 |
$149K |
| D0140 |
Limited oral evaluation - problem focused |
4,169 |
3,866 |
$128K |
| D1510 |
|
892 |
591 |
$126K |
| D2160 |
|
1,131 |
741 |
$100K |
| D2331 |
|
736 |
495 |
$65K |
| D0330 |
Panoramic radiographic image |
3,492 |
3,268 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
726 |
411 |
$55K |
| D2934 |
|
429 |
133 |
$55K |
| D2931 |
|
344 |
245 |
$51K |
| D3221 |
|
755 |
269 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,386 |
3,110 |
$48K |
| D8999 |
|
24 |
24 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,063 |
1,058 |
$35K |
| D2330 |
|
220 |
144 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
107 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
36 |
12 |
$7K |
| D7111 |
|
106 |
65 |
$5K |
| D0602 |
|
601 |
600 |
$3K |
| D2920 |
|
85 |
77 |
$2K |
| D2332 |
|
14 |
12 |
$2K |
| D1354 |
|
44 |
12 |
$600.00 |
| D0350 |
|
14 |
14 |
$0.00 |
| D0340 |
|
15 |
15 |
$0.00 |