| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25,237 |
11,518 |
$3.84M |
| D7140 |
Extraction, erupted tooth or exposed root |
27,462 |
17,040 |
$2.40M |
| D1206 |
Topical application of fluoride varnish |
80,546 |
79,480 |
$1.91M |
| D0120 |
Periodic oral evaluation - established patient |
49,694 |
49,249 |
$1.67M |
| D0240 |
|
51,778 |
26,115 |
$1.62M |
| D1351 |
Sealant - per tooth |
54,981 |
17,696 |
$1.38M |
| D0140 |
Limited oral evaluation - problem focused |
28,466 |
27,970 |
$1.27M |
| D9410 |
|
46,529 |
44,287 |
$1.15M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14,767 |
10,356 |
$1.04M |
| D0272 |
Bitewings - two radiographic images |
33,660 |
33,215 |
$995K |
| D1354 |
|
28,020 |
9,381 |
$924K |
| D1120 |
Prophylaxis - child |
28,715 |
28,367 |
$921K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,148 |
16,937 |
$771K |
| D0274 |
Bitewings - four radiographic images |
15,776 |
15,540 |
$661K |
| D2140 |
|
10,683 |
8,513 |
$599K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,596 |
6,324 |
$588K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,024 |
15,045 |
$527K |
| D1110 |
Prophylaxis - adult |
10,921 |
10,806 |
$526K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,777 |
4,565 |
$522K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27,727 |
24,504 |
$515K |
| D0220 |
Intraoral - periapical first radiographic image |
22,857 |
21,903 |
$435K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,408 |
5,356 |
$219K |
| D1330 |
|
7,429 |
7,361 |
$206K |
| D9920 |
|
4,096 |
3,814 |
$189K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,538 |
1,463 |
$184K |
| D2330 |
|
2,768 |
1,415 |
$165K |
| D9420 |
|
1,558 |
1,528 |
$49K |
| D2160 |
|
529 |
472 |
$40K |
| D2331 |
|
404 |
305 |
$32K |
| D0191 |
|
7,894 |
7,627 |
$14K |
| D1510 |
|
114 |
89 |
$14K |
| D9990 |
|
377 |
370 |
$7K |
| D0270 |
|
450 |
445 |
$6K |
| D9430 |
|
249 |
235 |
$3K |
| D0330 |
Panoramic radiographic image |
175 |
164 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
14 |
$2K |
| D2335 |
|
12 |
12 |
$1K |
| D1999 |
|
56,919 |
52,796 |
$1K |
| D2940 |
|
59 |
55 |
$965.38 |
| D1353 |
|
3,235 |
1,499 |
$814.59 |
| D3120 |
|
551 |
486 |
$588.48 |
| D4355 |
|
12 |
12 |
$560.83 |
| D1310 |
|
16 |
16 |
$458.80 |
| D9985 |
|
144 |
130 |
$127.51 |
| D3110 |
|
141 |
133 |
$73.56 |
| D9999 |
Unspecified adjunctive procedure, by report |
29 |
29 |
$0.00 |
| D9996 |
|
70 |
70 |
$0.00 |