| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,936 |
4,173 |
$2.31M |
| D0240 |
|
53,563 |
26,823 |
$1.27M |
| D0120 |
Periodic oral evaluation - established patient |
33,028 |
31,535 |
$855K |
| D1120 |
Prophylaxis - child |
23,136 |
22,062 |
$801K |
| D1208 |
Topical application of fluoride, excluding varnish |
36,107 |
34,581 |
$700K |
| D0272 |
Bitewings - two radiographic images |
28,540 |
27,460 |
$639K |
| D1110 |
Prophylaxis - adult |
13,134 |
12,663 |
$620K |
| D9248 |
|
5,739 |
5,353 |
$526K |
| D0210 |
Intraoral - complete series of radiographic images |
5,175 |
4,849 |
$417K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,095 |
2,849 |
$405K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,652 |
8,869 |
$242K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,027 |
1,495 |
$235K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,137 |
1,066 |
$152K |
| D0140 |
Limited oral evaluation - problem focused |
4,539 |
4,285 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,973 |
2,931 |
$98K |
| D0603 |
|
16,871 |
16,526 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
2,192 |
2,069 |
$37K |
| D0330 |
Panoramic radiographic image |
2,053 |
2,001 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
341 |
133 |
$29K |
| D2140 |
|
242 |
99 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
84 |
$7K |
| D1351 |
Sealant - per tooth |
203 |
58 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
54 |
$997.50 |
| D7111 |
|
19 |
14 |
$892.50 |