| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,463 |
1,416 |
$735K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,006 |
2,254 |
$477K |
| D0120 |
Periodic oral evaluation - established patient |
15,221 |
14,570 |
$375K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,027 |
1,829 |
$370K |
| D1120 |
Prophylaxis - child |
12,722 |
12,101 |
$330K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,276 |
15,584 |
$259K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,476 |
1,404 |
$183K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,990 |
3,655 |
$167K |
| D1110 |
Prophylaxis - adult |
4,590 |
4,410 |
$166K |
| D1351 |
Sealant - per tooth |
5,451 |
1,388 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,928 |
2,816 |
$126K |
| D2932 |
|
798 |
236 |
$108K |
| D0272 |
Bitewings - two radiographic images |
6,290 |
5,942 |
$105K |
| D9420 |
|
1,113 |
893 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,450 |
2,334 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
4,761 |
4,253 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,558 |
1,490 |
$55K |
| D0330 |
Panoramic radiographic image |
1,001 |
965 |
$50K |
| D0240 |
|
3,161 |
1,558 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,021 |
1,576 |
$34K |
| D2140 |
|
430 |
261 |
$31K |
| D1510 |
|
164 |
88 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
234 |
158 |
$22K |
| D2330 |
|
367 |
123 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
308 |
106 |
$19K |
| D9239 |
|
29 |
27 |
$2K |
| D9243 |
|
14 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
76 |
41 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$892.96 |
| D1206 |
Topical application of fluoride varnish |
38 |
28 |
$457.86 |
| D9248 |
|
331 |
316 |
$0.00 |