| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,918 |
5,440 |
$1.23M |
| D1120 |
Prophylaxis - child |
39,794 |
38,756 |
$1.13M |
| D0120 |
Periodic oral evaluation - established patient |
41,017 |
39,997 |
$788K |
| D1208 |
Topical application of fluoride, excluding varnish |
48,042 |
46,736 |
$709K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,884 |
4,877 |
$631K |
| D1999 |
|
26,330 |
25,217 |
$505K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,184 |
3,942 |
$456K |
| D0272 |
Bitewings - two radiographic images |
23,197 |
22,576 |
$414K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,589 |
3,992 |
$361K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,546 |
14,843 |
$342K |
| D0330 |
Panoramic radiographic image |
6,914 |
6,732 |
$325K |
| D1354 |
|
8,492 |
2,777 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,246 |
2,145 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,650 |
6,375 |
$165K |
| D1110 |
Prophylaxis - adult |
4,095 |
4,000 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
3,341 |
3,121 |
$91K |
| D1351 |
Sealant - per tooth |
3,429 |
1,129 |
$80K |
| D1206 |
Topical application of fluoride varnish |
4,081 |
3,956 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,927 |
4,735 |
$53K |
| D2140 |
|
496 |
406 |
$23K |
| D0274 |
Bitewings - four radiographic images |
766 |
753 |
$18K |
| D1510 |
|
111 |
97 |
$17K |
| D3230 |
|
86 |
37 |
$10K |
| D2330 |
|
150 |
100 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
342 |
312 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12 |
12 |
$660.00 |
| D3120 |
|
17 |
15 |
$360.00 |
| D1330 |
|
44 |
43 |
$0.00 |