| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22,427 |
9,041 |
$4.48M |
| D1120 |
Prophylaxis - child |
53,771 |
53,756 |
$2.36M |
| D1206 |
Topical application of fluoride varnish |
56,317 |
56,251 |
$1.65M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,956 |
9,521 |
$1.55M |
| D0120 |
Periodic oral evaluation - established patient |
41,205 |
41,193 |
$1.48M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,093 |
7,337 |
$1.41M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,020 |
6,213 |
$878K |
| D0140 |
Limited oral evaluation - problem focused |
12,477 |
12,160 |
$784K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,571 |
3,403 |
$726K |
| D1351 |
Sealant - per tooth |
18,486 |
6,552 |
$604K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,458 |
8,442 |
$527K |
| D0240 |
|
23,073 |
12,272 |
$493K |
| D0272 |
Bitewings - two radiographic images |
18,780 |
18,765 |
$487K |
| D1510 |
|
2,364 |
1,899 |
$463K |
| D2390 |
|
2,254 |
774 |
$456K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,229 |
11,684 |
$427K |
| D0220 |
Intraoral - periapical first radiographic image |
21,763 |
21,466 |
$419K |
| D0330 |
Panoramic radiographic image |
4,462 |
4,461 |
$327K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,845 |
6,843 |
$289K |
| D9420 |
|
1,416 |
1,409 |
$283K |
| D2330 |
|
2,685 |
1,780 |
$228K |
| D9920 |
|
2,865 |
2,791 |
$154K |
| D1354 |
|
5,153 |
2,121 |
$145K |
| D1110 |
Prophylaxis - adult |
2,564 |
2,561 |
$143K |
| D0274 |
Bitewings - four radiographic images |
2,451 |
2,450 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
3,033 |
2,582 |
$66K |
| D1517 |
|
179 |
178 |
$58K |
| D1516 |
|
87 |
87 |
$28K |
| D2331 |
|
237 |
177 |
$25K |
| D1515 |
|
21 |
17 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
25 |
$4K |
| D1556 |
|
27 |
24 |
$662.04 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$273.03 |
| D9986 |
|
156 |
153 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,516 |
2,379 |
$0.00 |
| D9987 |
|
26 |
26 |
$0.00 |
| D3120 |
|
17 |
14 |
$0.00 |