| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,421 |
4,434 |
$2.34M |
| D0120 |
Periodic oral evaluation - established patient |
78,298 |
76,747 |
$2.05M |
| D1120 |
Prophylaxis - child |
56,626 |
55,132 |
$1.55M |
| D1110 |
Prophylaxis - adult |
31,753 |
31,085 |
$1.22M |
| D1206 |
Topical application of fluoride varnish |
73,779 |
71,850 |
$1.21M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,878 |
8,180 |
$1.10M |
| D2140 |
|
11,272 |
6,842 |
$811K |
| D0220 |
Intraoral - periapical first radiographic image |
47,259 |
46,104 |
$713K |
| D1351 |
Sealant - per tooth |
24,433 |
8,806 |
$686K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,476 |
4,359 |
$663K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,630 |
13,703 |
$649K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,009 |
4,054 |
$633K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,153 |
4,317 |
$589K |
| D0330 |
Panoramic radiographic image |
11,054 |
10,775 |
$556K |
| D2934 |
|
2,901 |
801 |
$548K |
| D0274 |
Bitewings - four radiographic images |
16,993 |
16,626 |
$547K |
| D9243 |
|
4,791 |
960 |
$482K |
| D0272 |
Bitewings - two radiographic images |
24,089 |
23,596 |
$442K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,862 |
1,729 |
$388K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,789 |
6,539 |
$296K |
| D7240 |
Removal of impacted tooth - completely bony |
1,471 |
459 |
$272K |
| D7230 |
|
1,504 |
486 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,728 |
14,469 |
$232K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,464 |
12,251 |
$219K |
| D9420 |
|
1,856 |
1,729 |
$215K |
| D0140 |
Limited oral evaluation - problem focused |
4,502 |
4,317 |
$165K |
| D1354 |
|
16,112 |
4,343 |
$103K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,263 |
2,494 |
$92K |
| D9239 |
|
1,024 |
958 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
339 |
295 |
$43K |
| D9610 |
|
1,009 |
944 |
$34K |
| D2160 |
|
289 |
234 |
$32K |
| D0170 |
|
681 |
649 |
$19K |
| D7111 |
|
199 |
149 |
$10K |
| D1510 |
|
33 |
28 |
$7K |
| D0350 |
|
10,710 |
10,423 |
$3K |
| D2332 |
|
20 |
16 |
$2K |
| D2330 |
|
27 |
26 |
$2K |
| D2335 |
|
13 |
13 |
$2K |
| D2331 |
|
18 |
13 |
$1K |
| D1355 |
|
52 |
29 |
$99.00 |
| D1999 |
|
191 |
186 |
$0.00 |
| D0171 |
|
614 |
589 |
$0.00 |