| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,350 |
1,946 |
$590K |
| D1120 |
Prophylaxis - child |
13,468 |
13,331 |
$466K |
| D0120 |
Periodic oral evaluation - established patient |
16,737 |
16,506 |
$430K |
| D0272 |
Bitewings - two radiographic images |
15,266 |
15,149 |
$329K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,171 |
15,053 |
$293K |
| D1110 |
Prophylaxis - adult |
5,198 |
5,097 |
$245K |
| D0210 |
Intraoral - complete series of radiographic images |
2,826 |
2,569 |
$222K |
| D0220 |
Intraoral - periapical first radiographic image |
12,396 |
12,213 |
$216K |
| D0240 |
|
6,561 |
3,535 |
$154K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,645 |
10,504 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,166 |
1,322 |
$145K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,521 |
5,352 |
$138K |
| D9248 |
|
1,331 |
1,287 |
$123K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,343 |
865 |
$106K |
| D1206 |
Topical application of fluoride varnish |
4,278 |
4,155 |
$83K |
| D2140 |
|
1,201 |
824 |
$77K |
| D0603 |
|
14,680 |
14,464 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,691 |
1,626 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
664 |
439 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,480 |
1,474 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
686 |
484 |
$42K |
| D0330 |
Panoramic radiographic image |
1,124 |
1,122 |
$14K |
| D7111 |
|
242 |
176 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
111 |
53 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
327 |
327 |
$8K |
| D2330 |
|
78 |
57 |
$6K |
| D1351 |
Sealant - per tooth |
193 |
81 |
$5K |
| D0602 |
|
650 |
641 |
$3K |
| D0601 |
|
333 |
331 |
$1K |
| D0274 |
Bitewings - four radiographic images |
98 |
98 |
$1K |