| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21,856 |
8,060 |
$4.31M |
| D1120 |
Prophylaxis - child |
61,933 |
59,994 |
$2.82M |
| D1206 |
Topical application of fluoride varnish |
89,215 |
85,767 |
$2.41M |
| D1351 |
Sealant - per tooth |
62,165 |
18,043 |
$2.15M |
| D0120 |
Periodic oral evaluation - established patient |
59,274 |
57,204 |
$2.02M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,316 |
6,088 |
$1.41M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,104 |
5,995 |
$1.22M |
| D1110 |
Prophylaxis - adult |
19,973 |
19,310 |
$1.20M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,705 |
6,924 |
$1.15M |
| D0210 |
Intraoral - complete series of radiographic images |
11,244 |
10,799 |
$1.00M |
| D0274 |
Bitewings - four radiographic images |
16,970 |
16,382 |
$756K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,115 |
11,721 |
$668K |
| D2940 |
|
8,115 |
3,814 |
$628K |
| D0272 |
Bitewings - two radiographic images |
19,618 |
19,054 |
$628K |
| D9420 |
|
1,922 |
1,839 |
$462K |
| D1354 |
|
38,167 |
7,965 |
$446K |
| D0191 |
|
19,858 |
19,450 |
$418K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,022 |
2,147 |
$333K |
| D1510 |
|
1,522 |
1,100 |
$291K |
| D0140 |
Limited oral evaluation - problem focused |
5,320 |
5,055 |
$282K |
| D0220 |
Intraoral - periapical first radiographic image |
13,531 |
12,904 |
$274K |
| D2332 |
|
1,523 |
1,044 |
$230K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,598 |
7,295 |
$219K |
| D2330 |
|
1,789 |
1,191 |
$181K |
| D2140 |
|
1,974 |
1,493 |
$179K |
| D2335 |
|
827 |
611 |
$158K |
| D0330 |
Panoramic radiographic image |
1,975 |
1,888 |
$154K |
| D2331 |
|
1,121 |
743 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
531 |
454 |
$95K |
| D2160 |
|
707 |
532 |
$92K |
| D0273 |
|
1,336 |
1,279 |
$50K |
| D0240 |
|
1,749 |
932 |
$42K |
| D0270 |
|
1,441 |
1,369 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,283 |
14,676 |
$26K |
| D2390 |
|
202 |
50 |
$19K |
| D4346 |
|
106 |
106 |
$13K |
| D2933 |
|
112 |
37 |
$13K |
| D7111 |
|
148 |
108 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
111 |
58 |
$9K |
| D4355 |
|
25 |
24 |
$3K |
| D1556 |
|
42 |
40 |
$2K |
| D1310 |
|
14,713 |
14,233 |
$0.00 |
| D0601 |
|
88 |
87 |
$0.00 |
| D1330 |
|
85,801 |
82,869 |
$0.00 |
| D3120 |
|
1,598 |
1,223 |
$0.00 |
| D0603 |
|
88,419 |
84,688 |
$0.00 |
| D0602 |
|
1,250 |
1,240 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
4,763 |
4,588 |
$0.00 |
| D9430 |
|
1,201 |
1,161 |
$0.00 |