| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18,291 |
4,545 |
$2.34M |
| D0120 |
Periodic oral evaluation - established patient |
57,078 |
52,885 |
$1.42M |
| D1120 |
Prophylaxis - child |
36,918 |
34,053 |
$1.23M |
| D1110 |
Prophylaxis - adult |
14,129 |
13,213 |
$643K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,515 |
28,177 |
$574K |
| D0272 |
Bitewings - two radiographic images |
24,071 |
22,588 |
$512K |
| D8670 |
Periodic orthodontic treatment visit |
4,171 |
2,581 |
$446K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,335 |
3,103 |
$400K |
| D2140 |
|
4,594 |
2,730 |
$283K |
| D0240 |
|
11,998 |
8,524 |
$275K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,963 |
9,123 |
$243K |
| D0210 |
Intraoral - complete series of radiographic images |
3,492 |
3,405 |
$234K |
| D9248 |
|
2,180 |
2,116 |
$197K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,529 |
1,501 |
$193K |
| D1206 |
Topical application of fluoride varnish |
8,662 |
8,356 |
$163K |
| D0140 |
Limited oral evaluation - problem focused |
4,966 |
4,719 |
$152K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,607 |
598 |
$134K |
| D0330 |
Panoramic radiographic image |
2,991 |
2,934 |
$82K |
| D1351 |
Sealant - per tooth |
2,823 |
632 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
2,787 |
2,576 |
$41K |
| D2934 |
|
182 |
58 |
$21K |
| D2330 |
|
311 |
171 |
$20K |
| D0274 |
Bitewings - four radiographic images |
590 |
582 |
$15K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
27 |
26 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$721.05 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
13 |
$205.95 |
| D1999 |
|
286 |
283 |
$0.00 |