| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,042 |
6,119 |
$2.02M |
| D1120 |
Prophylaxis - child |
49,392 |
47,040 |
$1.43M |
| D0120 |
Periodic oral evaluation - established patient |
65,861 |
62,740 |
$1.28M |
| D1206 |
Topical application of fluoride varnish |
63,139 |
60,128 |
$1.24M |
| D1351 |
Sealant - per tooth |
48,081 |
9,400 |
$1.11M |
| D0272 |
Bitewings - two radiographic images |
56,313 |
53,508 |
$1.05M |
| D1110 |
Prophylaxis - adult |
25,617 |
24,422 |
$1.04M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,511 |
7,162 |
$1.00M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,347 |
11,482 |
$922K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,283 |
12,539 |
$857K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29,169 |
25,959 |
$749K |
| D0210 |
Intraoral - complete series of radiographic images |
13,123 |
11,175 |
$535K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,558 |
3,301 |
$450K |
| D2934 |
|
3,149 |
850 |
$354K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,895 |
9,435 |
$303K |
| D0140 |
Limited oral evaluation - problem focused |
9,297 |
8,616 |
$287K |
| D2330 |
|
3,379 |
2,009 |
$214K |
| D2332 |
|
1,967 |
1,196 |
$166K |
| D0240 |
|
13,636 |
8,887 |
$163K |
| D0330 |
Panoramic radiographic image |
8,545 |
7,892 |
$156K |
| D1354 |
|
1,724 |
576 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,329 |
1,142 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,891 |
6,530 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
6,523 |
6,006 |
$62K |
| D2940 |
|
1,027 |
781 |
$50K |
| D3230 |
|
354 |
155 |
$29K |
| D2335 |
|
263 |
174 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
87 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,993 |
1,109 |
$15K |
| D0270 |
|
913 |
848 |
$14K |
| D7111 |
|
131 |
71 |
$8K |
| D2331 |
|
54 |
41 |
$3K |
| D4346 |
|
13 |
13 |
$2K |
| D1515 |
|
58 |
51 |
$1K |
| D2920 |
|
14 |
14 |
$58.27 |
| D3120 |
|
2,364 |
1,827 |
$0.00 |
| D9420 |
|
88 |
76 |
$0.00 |
| D9215 |
|
75 |
75 |
$0.00 |
| D1352 |
|
23 |
14 |
$0.00 |
| D1999 |
|
482 |
450 |
$0.00 |