| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,796 |
4,895 |
$2.16M |
| D0145 |
Oral evaluation for a patient under three years of age |
14,982 |
14,832 |
$2.09M |
| D1351 |
Sealant - per tooth |
50,991 |
13,427 |
$1.37M |
| D1120 |
Prophylaxis - child |
36,200 |
35,791 |
$1.24M |
| D0120 |
Periodic oral evaluation - established patient |
42,153 |
41,643 |
$1.13M |
| D1206 |
Topical application of fluoride varnish |
45,066 |
44,510 |
$675K |
| D1110 |
Prophylaxis - adult |
11,025 |
10,868 |
$562K |
| D0220 |
Intraoral - periapical first radiographic image |
41,780 |
41,158 |
$502K |
| D0210 |
Intraoral - complete series of radiographic images |
6,213 |
6,147 |
$420K |
| D0272 |
Bitewings - two radiographic images |
18,125 |
17,911 |
$400K |
| D0274 |
Bitewings - four radiographic images |
11,892 |
11,727 |
$387K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,069 |
29,945 |
$332K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,445 |
2,832 |
$326K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,420 |
8,313 |
$288K |
| D9248 |
|
1,944 |
1,923 |
$226K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,581 |
8,438 |
$224K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,605 |
1,828 |
$187K |
| D0240 |
|
14,419 |
10,816 |
$135K |
| 40819 |
|
488 |
484 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
796 |
560 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,978 |
2,937 |
$59K |
| D0350 |
|
3,335 |
3,285 |
$55K |
| D2934 |
|
319 |
115 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,947 |
1,945 |
$34K |
| 41010 |
|
259 |
256 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
314 |
152 |
$24K |
| D7111 |
|
1,171 |
788 |
$19K |
| D9420 |
|
350 |
348 |
$15K |
| D0270 |
|
1,561 |
1,524 |
$9K |
| D1510 |
|
22 |
13 |
$3K |
| D0273 |
|
97 |
96 |
$3K |
| D2140 |
|
14 |
12 |
$746.90 |
| D1330 |
|
24 |
24 |
$171.50 |
| D1999 |
|
1,499 |
1,456 |
$0.00 |
| D0602 |
|
6,293 |
6,248 |
$0.00 |
| D0603 |
|
46,986 |
46,374 |
$0.00 |
| D0601 |
|
4,558 |
4,502 |
$0.00 |