| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,880 |
2,704 |
$846K |
| D1120 |
Prophylaxis - child |
20,558 |
19,326 |
$608K |
| D1206 |
Topical application of fluoride varnish |
22,840 |
21,567 |
$474K |
| D0120 |
Periodic oral evaluation - established patient |
22,835 |
21,622 |
$449K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,256 |
3,360 |
$436K |
| D1351 |
Sealant - per tooth |
15,498 |
2,774 |
$391K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,286 |
3,295 |
$377K |
| D9920 |
|
6,898 |
5,924 |
$277K |
| D0272 |
Bitewings - two radiographic images |
10,140 |
9,394 |
$215K |
| D2140 |
|
4,255 |
2,635 |
$212K |
| D1110 |
Prophylaxis - adult |
4,932 |
4,677 |
$202K |
| D0330 |
Panoramic radiographic image |
2,736 |
2,620 |
$157K |
| D2335 |
|
910 |
454 |
$121K |
| D2332 |
|
1,235 |
729 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,349 |
2,977 |
$90K |
| D2330 |
|
1,293 |
840 |
$87K |
| D2331 |
|
911 |
603 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
895 |
527 |
$69K |
| D0240 |
|
5,603 |
2,924 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,980 |
1,882 |
$62K |
| D1510 |
|
403 |
277 |
$61K |
| D2160 |
|
503 |
365 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,322 |
1,184 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,358 |
2,189 |
$11K |
| D1354 |
|
126 |
35 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,123 |
807 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
64 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
79 |
$6K |
| D2920 |
|
72 |
59 |
$4K |