| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,349 |
6,671 |
$2.25M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20,457 |
5,962 |
$1.64M |
| D1120 |
Prophylaxis - child |
43,302 |
42,143 |
$1.44M |
| D0120 |
Periodic oral evaluation - established patient |
53,971 |
52,693 |
$1.30M |
| D1206 |
Topical application of fluoride varnish |
60,837 |
59,337 |
$1.26M |
| D7140 |
Extraction, erupted tooth or exposed root |
17,101 |
9,889 |
$1.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,160 |
8,216 |
$901K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30,794 |
28,292 |
$872K |
| D1110 |
Prophylaxis - adult |
19,015 |
18,589 |
$798K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,699 |
7,854 |
$717K |
| D1351 |
Sealant - per tooth |
17,433 |
7,104 |
$519K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,110 |
4,858 |
$507K |
| D0274 |
Bitewings - four radiographic images |
14,592 |
14,238 |
$385K |
| D0272 |
Bitewings - two radiographic images |
22,219 |
21,572 |
$375K |
| D0330 |
Panoramic radiographic image |
9,480 |
9,244 |
$373K |
| D2933 |
|
2,018 |
676 |
$309K |
| D2140 |
|
4,049 |
2,994 |
$241K |
| D0220 |
Intraoral - periapical first radiographic image |
15,682 |
14,567 |
$177K |
| D1510 |
|
1,100 |
899 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,290 |
5,140 |
$149K |
| D2934 |
|
968 |
331 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
3,847 |
3,719 |
$80K |
| D9110 |
|
1,314 |
1,253 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,495 |
2,758 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
662 |
649 |
$14K |
| D2160 |
|
174 |
130 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
141 |
125 |
$12K |
| D2330 |
|
158 |
97 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
121 |
120 |
$2K |
| D1999 |
|
12,939 |
11,745 |
$0.00 |
| D0602 |
|
12,816 |
12,478 |
$0.00 |
| D0603 |
|
17,075 |
16,719 |
$0.00 |
| D0601 |
|
8,273 |
8,087 |
$0.00 |
| D1330 |
|
51 |
51 |
$0.00 |