| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,606 |
7,058 |
$2.32M |
| D1120 |
Prophylaxis - child |
39,199 |
37,089 |
$1.19M |
| D1206 |
Topical application of fluoride varnish |
53,438 |
50,580 |
$1.02M |
| D0120 |
Periodic oral evaluation - established patient |
47,859 |
45,392 |
$944K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,822 |
3,786 |
$905K |
| D1351 |
Sealant - per tooth |
36,012 |
10,489 |
$847K |
| D1354 |
|
8,462 |
3,182 |
$651K |
| D1110 |
Prophylaxis - adult |
14,925 |
14,141 |
$619K |
| D0272 |
Bitewings - two radiographic images |
28,231 |
26,645 |
$580K |
| D2934 |
|
4,162 |
1,028 |
$553K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,397 |
3,831 |
$479K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,339 |
16,045 |
$470K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,985 |
4,158 |
$405K |
| D2140 |
|
6,361 |
4,611 |
$323K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,925 |
8,333 |
$284K |
| D1510 |
|
1,734 |
1,415 |
$271K |
| D0330 |
Panoramic radiographic image |
5,404 |
5,068 |
$231K |
| D0210 |
Intraoral - complete series of radiographic images |
4,602 |
4,435 |
$198K |
| D0240 |
|
11,412 |
6,170 |
$165K |
| D0274 |
Bitewings - four radiographic images |
5,048 |
4,730 |
$141K |
| D2330 |
|
2,131 |
1,143 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
3,983 |
3,733 |
$128K |
| D7111 |
|
1,051 |
757 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
2,521 |
2,370 |
$28K |
| D2332 |
|
33 |
24 |
$4K |
| D2331 |
|
36 |
27 |
$3K |
| D2160 |
|
32 |
27 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
140 |
85 |
$946.06 |
| D0270 |
|
29 |
27 |
$466.83 |
| D2335 |
|
16 |
13 |
$309.48 |
| D1999 |
|
94 |
93 |
$0.00 |
| D9420 |
|
662 |
612 |
$0.00 |