| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,110 |
1,891 |
$231K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,673 |
850 |
$190K |
| D1120 |
Prophylaxis - child |
4,269 |
4,255 |
$144K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,240 |
2,904 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
2,933 |
2,923 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,917 |
1,239 |
$101K |
| D1351 |
Sealant - per tooth |
2,920 |
1,100 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,175 |
834 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
911 |
911 |
$53K |
| D9430 |
|
1,431 |
1,321 |
$45K |
| D2330 |
|
440 |
258 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,762 |
2,752 |
$33K |
| D0350 |
|
3,267 |
1,247 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,487 |
2,473 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,684 |
2,867 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,201 |
1,195 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
241 |
149 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,077 |
1,059 |
$12K |
| D1310 |
|
222 |
221 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
138 |
$7K |
| D1510 |
|
53 |
39 |
$5K |
| D0330 |
Panoramic radiographic image |
149 |
149 |
$4K |
| D2940 |
|
65 |
42 |
$3K |
| D9248 |
|
54 |
53 |
$2K |
| D0603 |
|
98 |
98 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
29 |
29 |
$0.00 |
| D1330 |
|
104 |
104 |
$0.00 |
| D9993 |
|
13 |
13 |
$0.00 |