| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,364 |
3,205 |
$1.82M |
| D1120 |
Prophylaxis - child |
26,022 |
25,709 |
$912K |
| D0120 |
Periodic oral evaluation - established patient |
30,562 |
30,230 |
$818K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,795 |
2,517 |
$567K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,360 |
3,248 |
$539K |
| D0272 |
Bitewings - two radiographic images |
23,363 |
23,108 |
$504K |
| D1206 |
Topical application of fluoride varnish |
30,431 |
30,117 |
$500K |
| D0220 |
Intraoral - periapical first radiographic image |
28,450 |
28,026 |
$427K |
| D1110 |
Prophylaxis - adult |
7,798 |
7,740 |
$386K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,017 |
26,158 |
$346K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,110 |
2,971 |
$335K |
| D2934 |
|
1,814 |
498 |
$255K |
| D9248 |
|
2,430 |
2,331 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,890 |
2,083 |
$229K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,082 |
7,824 |
$187K |
| D0210 |
Intraoral - complete series of radiographic images |
2,312 |
2,267 |
$167K |
| D0140 |
Limited oral evaluation - problem focused |
3,979 |
3,901 |
$112K |
| D0274 |
Bitewings - four radiographic images |
3,669 |
3,656 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,174 |
647 |
$92K |
| D1351 |
Sealant - per tooth |
3,367 |
875 |
$88K |
| D2330 |
|
1,049 |
604 |
$75K |
| D2140 |
|
1,148 |
584 |
$74K |
| D0330 |
Panoramic radiographic image |
2,665 |
2,645 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,197 |
3,144 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,852 |
1,832 |
$61K |
| D1510 |
|
360 |
279 |
$56K |
| D0603 |
|
20,381 |
20,174 |
$46K |
| D0602 |
|
11,212 |
11,095 |
$22K |
| D2332 |
|
58 |
38 |
$6K |
| D0270 |
|
86 |
86 |
$551.69 |
| D1999 |
|
1,558 |
1,508 |
$5.00 |