| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,855 |
4,697 |
$2.24M |
| D1120 |
Prophylaxis - child |
64,562 |
63,472 |
$1.90M |
| D0120 |
Periodic oral evaluation - established patient |
55,709 |
54,791 |
$1.14M |
| D7140 |
Extraction, erupted tooth or exposed root |
10,204 |
4,709 |
$852K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,789 |
9,298 |
$824K |
| D1206 |
Topical application of fluoride varnish |
63,941 |
62,858 |
$799K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,659 |
5,614 |
$371K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,816 |
21,863 |
$364K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,907 |
12,671 |
$342K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,907 |
15,815 |
$339K |
| D1351 |
Sealant - per tooth |
19,407 |
5,855 |
$318K |
| D0140 |
Limited oral evaluation - problem focused |
11,764 |
11,181 |
$297K |
| D0220 |
Intraoral - periapical first radiographic image |
30,596 |
29,445 |
$282K |
| D0272 |
Bitewings - two radiographic images |
21,646 |
21,135 |
$268K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,653 |
1,613 |
$264K |
| D0240 |
|
17,923 |
9,858 |
$211K |
| D0603 |
|
38,470 |
37,780 |
$176K |
| D2929 |
|
783 |
201 |
$176K |
| D1110 |
Prophylaxis - adult |
6,062 |
5,953 |
$137K |
| D0330 |
Panoramic radiographic image |
4,625 |
4,536 |
$125K |
| D0274 |
Bitewings - four radiographic images |
5,400 |
5,271 |
$71K |
| D9996 |
|
1,347 |
1,243 |
$59K |
| D0602 |
|
12,775 |
12,390 |
$38K |
| D1354 |
|
5,705 |
1,967 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,752 |
1,729 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
194 |
$14K |
| D0270 |
|
1,206 |
1,190 |
$11K |
| D2332 |
|
71 |
43 |
$7K |
| D2330 |
|
113 |
57 |
$6K |
| D0601 |
|
1,055 |
1,045 |
$6K |
| D9310 |
|
99 |
92 |
$4K |
| D1510 |
|
14 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
83 |
82 |
$2K |
| D0273 |
|
67 |
67 |
$1K |
| D9630 |
|
122 |
120 |
$481.50 |
| D9920 |
|
33 |
32 |
$412.74 |
| D1330 |
|
9,251 |
9,044 |
$109.36 |
| D9215 |
|
713 |
640 |
$0.00 |
| D0171 |
|
70 |
63 |
$0.00 |
| D1310 |
|
73 |
69 |
$0.00 |
| D9992 |
|
60 |
59 |
$0.00 |
| D0350 |
|
12,152 |
1,112 |
$0.00 |
| D1999 |
|
2,835 |
2,588 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
120 |
92 |
$0.00 |
| D2140 |
|
32 |
27 |
$0.00 |
| D0191 |
|
35 |
34 |
$0.00 |