| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22,692 |
5,041 |
$2.77M |
| D1120 |
Prophylaxis - child |
40,181 |
34,957 |
$916K |
| D0120 |
Periodic oral evaluation - established patient |
38,954 |
33,945 |
$773K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,783 |
3,742 |
$656K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,105 |
3,578 |
$579K |
| D1206 |
Topical application of fluoride varnish |
27,582 |
23,567 |
$527K |
| D0330 |
Panoramic radiographic image |
8,032 |
7,117 |
$417K |
| D1351 |
Sealant - per tooth |
15,477 |
4,213 |
$387K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,508 |
9,133 |
$313K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,224 |
18,110 |
$302K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,820 |
1,661 |
$300K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,584 |
2,268 |
$294K |
| D1110 |
Prophylaxis - adult |
7,254 |
6,264 |
$277K |
| D0272 |
Bitewings - two radiographic images |
26,251 |
22,832 |
$276K |
| D0240 |
|
20,400 |
7,508 |
$194K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,833 |
9,972 |
$193K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,106 |
1,064 |
$176K |
| D8670 |
Periodic orthodontic treatment visit |
483 |
343 |
$153K |
| D0274 |
Bitewings - four radiographic images |
6,985 |
6,039 |
$149K |
| D0140 |
Limited oral evaluation - problem focused |
3,405 |
3,016 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
15,312 |
13,043 |
$86K |
| D1354 |
|
3,702 |
1,014 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,613 |
2,144 |
$75K |
| D0340 |
|
862 |
634 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
994 |
378 |
$53K |
| D2332 |
|
433 |
188 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
837 |
732 |
$38K |
| D2140 |
|
323 |
214 |
$13K |
| D1510 |
|
89 |
84 |
$10K |
| D0470 |
|
268 |
209 |
$8K |
| D2335 |
|
33 |
15 |
$6K |
| D0350 |
|
287 |
228 |
$6K |
| D2933 |
|
34 |
13 |
$5K |
| D2330 |
|
49 |
16 |
$4K |
| D0180 |
|
29 |
24 |
$289.85 |
| D1330 |
|
1,282 |
1,243 |
$0.00 |
| D9310 |
|
136 |
91 |
$0.00 |