| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,401 |
3,253 |
$1.64M |
| D0120 |
Periodic oral evaluation - established patient |
29,892 |
27,627 |
$753K |
| D1120 |
Prophylaxis - child |
21,458 |
19,716 |
$715K |
| D0272 |
Bitewings - two radiographic images |
19,632 |
18,314 |
$445K |
| D1110 |
Prophylaxis - adult |
8,410 |
7,888 |
$380K |
| D1206 |
Topical application of fluoride varnish |
15,151 |
13,856 |
$285K |
| D2140 |
|
4,536 |
2,677 |
$277K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,605 |
12,693 |
$256K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,538 |
1,825 |
$233K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,281 |
6,562 |
$181K |
| D9248 |
|
1,447 |
1,361 |
$131K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,390 |
970 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
3,219 |
2,942 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
3,297 |
2,917 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
663 |
645 |
$48K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
521 |
285 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,334 |
1,175 |
$30K |
| D7111 |
|
209 |
128 |
$9K |
| D1351 |
Sealant - per tooth |
304 |
73 |
$8K |
| D0330 |
Panoramic radiographic image |
189 |
185 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$1K |