| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,085 |
2,324 |
$491K |
| D1120 |
Prophylaxis - child |
11,018 |
10,630 |
$337K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,151 |
7,842 |
$278K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,075 |
1,839 |
$219K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,458 |
1,930 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,782 |
9,365 |
$171K |
| D0240 |
|
11,302 |
6,265 |
$139K |
| D1206 |
Topical application of fluoride varnish |
6,166 |
5,901 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,686 |
991 |
$111K |
| D1351 |
Sealant - per tooth |
4,335 |
1,654 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,625 |
3,511 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,658 |
2,523 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
847 |
537 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,655 |
2,560 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,198 |
1,139 |
$35K |
| D2330 |
|
338 |
117 |
$24K |
| D2331 |
|
239 |
93 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
168 |
116 |
$12K |
| D2140 |
|
227 |
133 |
$12K |
| D1110 |
Prophylaxis - adult |
76 |
74 |
$3K |
| D2160 |
|
14 |
13 |
$1K |