| Code | Description | Claims | Beneficiaries | Total Paid |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,231 |
2,354 |
$1.68M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,661 |
4,892 |
$854K |
| D0120 |
Periodic oral evaluation - established patient |
25,736 |
25,404 |
$537K |
| D1120 |
Prophylaxis - child |
17,872 |
17,587 |
$532K |
| D1110 |
Prophylaxis - adult |
10,585 |
10,466 |
$474K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,330 |
3,247 |
$313K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,317 |
20,317 |
$301K |
| D0220 |
Intraoral - periapical first radiographic image |
18,929 |
18,625 |
$282K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,815 |
1,869 |
$246K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,174 |
8,539 |
$244K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
852 |
845 |
$240K |
| D0330 |
Panoramic radiographic image |
4,593 |
4,533 |
$219K |
| D0274 |
Bitewings - four radiographic images |
6,295 |
6,227 |
$189K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,213 |
820 |
$180K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,024 |
16,236 |
$157K |
| D1206 |
Topical application of fluoride varnish |
8,076 |
7,650 |
$146K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,647 |
640 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
4,829 |
4,779 |
$143K |
| D0272 |
Bitewings - two radiographic images |
7,192 |
7,103 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,894 |
2,834 |
$85K |
| D1351 |
Sealant - per tooth |
3,391 |
905 |
$81K |
| D9222 |
|
780 |
773 |
$61K |
| D7240 |
Removal of impacted tooth - completely bony |
265 |
73 |
$54K |
| D2390 |
|
239 |
66 |
$50K |
| D1354 |
|
559 |
98 |
$42K |
| D9610 |
|
752 |
744 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
299 |
279 |
$9K |
| D4341 |
|
41 |
12 |
$7K |
| D2330 |
|
40 |
26 |
$2K |
| D0350 |
|
56 |
56 |
$2K |
| D4910 |
|
26 |
26 |
$2K |
| D9310 |
|
15 |
15 |
$731.70 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
13 |
$382.09 |