| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,504 |
2,997 |
$829K |
| D1120 |
Prophylaxis - child |
17,655 |
16,958 |
$562K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,891 |
3,925 |
$503K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,985 |
4,030 |
$469K |
| D0120 |
Periodic oral evaluation - established patient |
18,831 |
18,110 |
$428K |
| D8670 |
Periodic orthodontic treatment visit |
4,418 |
4,275 |
$408K |
| D1206 |
Topical application of fluoride varnish |
19,479 |
18,688 |
$379K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,257 |
3,896 |
$346K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,927 |
8,397 |
$245K |
| D1110 |
Prophylaxis - adult |
5,287 |
5,065 |
$211K |
| D1351 |
Sealant - per tooth |
8,192 |
2,755 |
$204K |
| D0210 |
Intraoral - complete series of radiographic images |
3,635 |
3,463 |
$184K |
| D9248 |
|
2,139 |
1,970 |
$166K |
| D0272 |
Bitewings - two radiographic images |
8,868 |
8,444 |
$127K |
| D0274 |
Bitewings - four radiographic images |
4,076 |
3,894 |
$92K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,242 |
574 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,730 |
2,603 |
$73K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
54 |
53 |
$61K |
| D2330 |
|
1,052 |
674 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,978 |
2,910 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,237 |
3,812 |
$45K |
| D8660 |
|
1,021 |
997 |
$44K |
| D2929 |
|
473 |
126 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,439 |
1,337 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,257 |
1,236 |
$27K |
| D2332 |
|
322 |
219 |
$24K |
| D1510 |
|
181 |
133 |
$24K |
| D3230 |
|
226 |
53 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
105 |
$11K |
| D2390 |
|
80 |
58 |
$11K |
| D0330 |
Panoramic radiographic image |
276 |
266 |
$11K |
| D2331 |
|
134 |
85 |
$7K |
| D2931 |
|
48 |
40 |
$6K |
| D1517 |
|
35 |
27 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
663 |
525 |
$5K |
| D9110 |
|
15 |
15 |
$633.75 |
| D1354 |
|
104 |
42 |
$553.85 |
| D9420 |
|
92 |
69 |
$0.00 |
| D1999 |
|
4,031 |
3,590 |
$0.00 |