| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,912 |
5,313 |
$1.31M |
| D1351 |
Sealant - per tooth |
43,165 |
10,506 |
$988K |
| D1120 |
Prophylaxis - child |
25,406 |
24,280 |
$685K |
| D1206 |
Topical application of fluoride varnish |
27,940 |
26,674 |
$531K |
| D0120 |
Periodic oral evaluation - established patient |
26,679 |
25,555 |
$502K |
| D0272 |
Bitewings - two radiographic images |
21,833 |
20,834 |
$412K |
| D2140 |
|
7,246 |
5,042 |
$333K |
| D1110 |
Prophylaxis - adult |
9,013 |
8,603 |
$330K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,722 |
11,211 |
$307K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,055 |
2,749 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,578 |
9,094 |
$237K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,517 |
2,201 |
$231K |
| D0274 |
Bitewings - four radiographic images |
8,283 |
7,869 |
$219K |
| D0210 |
Intraoral - complete series of radiographic images |
6,827 |
6,361 |
$190K |
| D4346 |
|
1,233 |
1,192 |
$176K |
| D0220 |
Intraoral - periapical first radiographic image |
14,871 |
13,981 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,297 |
12,090 |
$109K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,389 |
998 |
$107K |
| D0330 |
Panoramic radiographic image |
2,441 |
2,194 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,231 |
6,956 |
$74K |
| D7111 |
|
1,270 |
916 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,630 |
1,531 |
$41K |
| D1354 |
|
395 |
120 |
$38K |
| D9920 |
|
1,103 |
843 |
$25K |
| D2160 |
|
392 |
279 |
$23K |
| D2330 |
|
151 |
115 |
$5K |
| D1999 |
|
2,043 |
1,691 |
$4K |