| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,935 |
7,262 |
$2.38M |
| D3240 |
|
8,629 |
3,654 |
$1.32M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,789 |
7,054 |
$1.31M |
| D3230 |
|
9,473 |
3,254 |
$1.18M |
| D0240 |
|
57,293 |
28,118 |
$1.01M |
| D1120 |
Prophylaxis - child |
28,092 |
27,409 |
$796K |
| D0120 |
Periodic oral evaluation - established patient |
33,663 |
32,838 |
$637K |
| D1208 |
Topical application of fluoride, excluding varnish |
36,042 |
35,158 |
$533K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,098 |
4,221 |
$484K |
| D1999 |
|
24,073 |
23,597 |
$473K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,091 |
14,352 |
$444K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,864 |
3,558 |
$425K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,756 |
2,107 |
$423K |
| D0272 |
Bitewings - two radiographic images |
22,413 |
21,642 |
$388K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,434 |
15,777 |
$344K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,483 |
2,152 |
$310K |
| D1206 |
Topical application of fluoride varnish |
11,537 |
11,147 |
$213K |
| D0220 |
Intraoral - periapical first radiographic image |
19,217 |
18,683 |
$206K |
| D1110 |
Prophylaxis - adult |
5,156 |
5,076 |
$187K |
| D0140 |
Limited oral evaluation - problem focused |
6,833 |
6,480 |
$184K |
| D1351 |
Sealant - per tooth |
5,117 |
1,465 |
$124K |
| D0330 |
Panoramic radiographic image |
2,574 |
2,513 |
$121K |
| D2332 |
|
1,034 |
626 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,239 |
3,169 |
$79K |
| D2330 |
|
1,328 |
820 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,988 |
1,937 |
$45K |
| D1510 |
|
62 |
52 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
164 |
162 |
$4K |
| D9248 |
|
5,223 |
4,999 |
$0.00 |