| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,377 |
2,662 |
$1.42M |
| D0120 |
Periodic oral evaluation - established patient |
47,130 |
44,817 |
$1.23M |
| D0240 |
|
43,808 |
21,676 |
$1.04M |
| D1120 |
Prophylaxis - child |
28,447 |
26,993 |
$992K |
| D1110 |
Prophylaxis - adult |
19,745 |
18,936 |
$938K |
| D0272 |
Bitewings - two radiographic images |
40,768 |
38,878 |
$935K |
| D1206 |
Topical application of fluoride varnish |
48,004 |
45,710 |
$930K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,044 |
10,079 |
$277K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,347 |
2,153 |
$261K |
| D2140 |
|
3,601 |
2,327 |
$227K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,753 |
1,677 |
$182K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,945 |
928 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
1,516 |
1,457 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,522 |
1,069 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,819 |
1,298 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
6,407 |
6,184 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
1,726 |
1,606 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
941 |
931 |
$31K |
| D1351 |
Sealant - per tooth |
1,061 |
322 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,897 |
1,786 |
$25K |
| D9248 |
|
115 |
88 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
142 |
140 |
$4K |
| D0330 |
Panoramic radiographic image |
325 |
325 |
$3K |
| D1510 |
|
17 |
12 |
$3K |
| D2160 |
|
28 |
14 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$1K |