| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,267 |
4,944 |
$1.69M |
| D0120 |
Periodic oral evaluation - established patient |
23,171 |
23,038 |
$1.57M |
| D1120 |
Prophylaxis - child |
32,430 |
32,204 |
$1.44M |
| D0230 |
Intraoral - periapical each additional radiographic image |
237,894 |
33,378 |
$968K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12,324 |
5,078 |
$819K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,636 |
9,581 |
$654K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,914 |
2,300 |
$653K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,982 |
5,541 |
$625K |
| D1208 |
Topical application of fluoride, excluding varnish |
32,335 |
32,119 |
$531K |
| D3240 |
|
4,674 |
1,886 |
$459K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,537 |
3,412 |
$436K |
| D1310 |
|
9,872 |
9,796 |
$417K |
| D2330 |
|
5,362 |
2,600 |
$411K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,588 |
3,848 |
$410K |
| D0220 |
Intraoral - periapical first radiographic image |
32,217 |
31,331 |
$372K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,067 |
5,035 |
$337K |
| D2140 |
|
5,980 |
3,160 |
$322K |
| D1351 |
Sealant - per tooth |
9,806 |
2,811 |
$286K |
| D9248 |
|
8,135 |
8,016 |
$276K |
| D2390 |
|
2,454 |
955 |
$255K |
| D0350 |
|
20,399 |
8,355 |
$224K |
| D3230 |
|
1,943 |
774 |
$191K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,515 |
4,423 |
$178K |
| D2160 |
|
1,631 |
1,134 |
$129K |
| D0210 |
Intraoral - complete series of radiographic images |
2,872 |
2,868 |
$120K |
| D9430 |
|
2,770 |
2,727 |
$89K |
| D2331 |
|
1,035 |
657 |
$81K |
| D0601 |
|
5,406 |
5,363 |
$71K |
| D1510 |
|
352 |
324 |
$62K |
| D0272 |
Bitewings - two radiographic images |
4,420 |
4,369 |
$52K |
| D2332 |
|
561 |
375 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
542 |
402 |
$43K |
| D0603 |
|
2,620 |
2,603 |
$38K |
| D0602 |
|
1,972 |
1,958 |
$28K |
| D7111 |
|
129 |
76 |
$7K |
| D1999 |
|
199 |
199 |
$15.00 |
| D9993 |
|
200 |
200 |
$0.00 |