| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,580 |
12,186 |
$6.05M |
| D7140 |
Extraction, erupted tooth or exposed root |
23,173 |
15,194 |
$3.26M |
| D1120 |
Prophylaxis - child |
25,740 |
23,968 |
$1.07M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
23,780 |
21,533 |
$989K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,401 |
7,609 |
$904K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,457 |
5,417 |
$739K |
| D0120 |
Periodic oral evaluation - established patient |
22,494 |
20,980 |
$683K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,483 |
17,051 |
$658K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,034 |
15,081 |
$657K |
| D1206 |
Topical application of fluoride varnish |
20,461 |
18,986 |
$600K |
| D1510 |
|
2,083 |
1,684 |
$560K |
| D1351 |
Sealant - per tooth |
8,691 |
5,709 |
$510K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,698 |
2,985 |
$509K |
| D1354 |
|
9,984 |
6,240 |
$460K |
| D2335 |
|
1,868 |
1,350 |
$387K |
| D2330 |
|
3,689 |
2,863 |
$386K |
| D0220 |
Intraoral - periapical first radiographic image |
27,537 |
24,983 |
$382K |
| D2331 |
|
2,778 |
2,216 |
$356K |
| D9248 |
|
1,962 |
1,793 |
$238K |
| D0330 |
Panoramic radiographic image |
4,216 |
4,014 |
$236K |
| D0140 |
Limited oral evaluation - problem focused |
6,687 |
6,168 |
$201K |
| D0272 |
Bitewings - two radiographic images |
8,362 |
7,782 |
$153K |
| D2931 |
|
375 |
327 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
3,109 |
2,961 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,669 |
1,562 |
$40K |
| D2940 |
|
1,052 |
891 |
$37K |
| D0274 |
Bitewings - four radiographic images |
950 |
846 |
$23K |
| D1517 |
|
86 |
74 |
$13K |
| D9630 |
|
341 |
307 |
$8K |
| D2332 |
|
16 |
14 |
$3K |
| D1515 |
|
19 |
17 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$941.40 |
| D0270 |
|
30 |
25 |
$208.20 |
| D1310 |
|
42 |
41 |
$0.00 |