| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
67,096 |
33,390 |
$1.57M |
| D0120 |
Periodic oral evaluation - established patient |
43,070 |
40,445 |
$1.10M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,144 |
3,388 |
$1.09M |
| D1120 |
Prophylaxis - child |
26,532 |
24,866 |
$874K |
| D1208 |
Topical application of fluoride, excluding varnish |
43,357 |
40,786 |
$837K |
| D1110 |
Prophylaxis - adult |
18,071 |
17,094 |
$827K |
| D0272 |
Bitewings - two radiographic images |
35,557 |
33,553 |
$807K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,198 |
13,949 |
$376K |
| D9248 |
|
3,785 |
3,561 |
$349K |
| D2140 |
|
5,155 |
3,767 |
$319K |
| D0210 |
Intraoral - complete series of radiographic images |
3,074 |
2,886 |
$220K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,245 |
1,667 |
$172K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,271 |
559 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
4,904 |
4,560 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,507 |
1,411 |
$46K |
| D1354 |
|
3,958 |
1,449 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
467 |
263 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,748 |
1,558 |
$23K |
| D0330 |
Panoramic radiographic image |
354 |
347 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
344 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
163 |
130 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
30 |
$3K |