| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,860 |
1,521 |
$670K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,046 |
6,436 |
$296K |
| D1120 |
Prophylaxis - child |
10,344 |
9,550 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
9,641 |
8,818 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,169 |
1,244 |
$224K |
| D1206 |
Topical application of fluoride varnish |
13,644 |
12,612 |
$207K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,954 |
936 |
$158K |
| D1351 |
Sealant - per tooth |
5,813 |
1,984 |
$155K |
| D0240 |
|
8,316 |
4,214 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
3,485 |
3,021 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,873 |
978 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,611 |
2,511 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,488 |
796 |
$107K |
| D2140 |
|
1,521 |
826 |
$103K |
| D0272 |
Bitewings - two radiographic images |
4,978 |
4,620 |
$86K |
| D9420 |
|
631 |
579 |
$70K |
| D1110 |
Prophylaxis - adult |
1,784 |
1,641 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
3,410 |
3,123 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,755 |
1,331 |
$42K |
| D0330 |
Panoramic radiographic image |
590 |
569 |
$29K |
| D2390 |
|
169 |
60 |
$27K |
| D9110 |
|
444 |
390 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
177 |
145 |
$16K |
| D0274 |
Bitewings - four radiographic images |
501 |
455 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
261 |
255 |
$9K |
| D4355 |
|
119 |
119 |
$8K |
| D0170 |
|
99 |
91 |
$3K |
| D9440 |
|
42 |
32 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
15 |
$2K |
| D2330 |
|
19 |
14 |
$1K |