| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,963 |
3,808 |
$1.92M |
| D1120 |
Prophylaxis - child |
20,892 |
20,837 |
$766K |
| D0120 |
Periodic oral evaluation - established patient |
24,276 |
24,242 |
$709K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,059 |
4,720 |
$612K |
| D2140 |
|
6,944 |
5,051 |
$509K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,895 |
3,000 |
$482K |
| D1110 |
Prophylaxis - adult |
9,291 |
9,275 |
$480K |
| D0272 |
Bitewings - two radiographic images |
15,999 |
15,936 |
$354K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,767 |
16,725 |
$347K |
| D0330 |
Panoramic radiographic image |
4,662 |
4,657 |
$310K |
| D1206 |
Topical application of fluoride varnish |
9,844 |
9,825 |
$261K |
| D2160 |
|
1,676 |
1,302 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,399 |
3,344 |
$163K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,196 |
2,193 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
6,005 |
5,900 |
$88K |
| D9420 |
|
746 |
671 |
$67K |
| D1351 |
Sealant - per tooth |
1,809 |
659 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
443 |
264 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
2,334 |
2,306 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
475 |
472 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,791 |
1,997 |
$27K |
| D2330 |
|
194 |
117 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
110 |
109 |
$4K |