| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,281 |
1,848 |
$551K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,352 |
3,479 |
$162K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,383 |
655 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,090 |
8,065 |
$133K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,951 |
1,943 |
$126K |
| D9420 |
|
535 |
473 |
$91K |
| D0240 |
|
18,818 |
9,695 |
$76K |
| D9310 |
|
4,079 |
3,929 |
$64K |
| D7230 |
|
751 |
423 |
$61K |
| D7250 |
|
1,127 |
418 |
$60K |
| D2390 |
|
282 |
97 |
$55K |
| D7241 |
|
557 |
243 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,979 |
4,686 |
$46K |
| D0330 |
Panoramic radiographic image |
5,230 |
5,029 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,618 |
8,732 |
$35K |
| D0170 |
|
1,387 |
1,294 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,098 |
15,905 |
$25K |
| D2330 |
|
513 |
305 |
$23K |
| D0272 |
Bitewings - two radiographic images |
9,267 |
9,030 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
27,576 |
26,627 |
$19K |
| D7220 |
|
360 |
215 |
$19K |
| D1351 |
Sealant - per tooth |
9,970 |
3,505 |
$18K |
| D1120 |
Prophylaxis - child |
22,591 |
22,133 |
$17K |
| D1206 |
Topical application of fluoride varnish |
42,008 |
40,721 |
$14K |
| D0274 |
Bitewings - four radiographic images |
12,002 |
11,754 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
12,425 |
11,833 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
25,728 |
25,292 |
$5K |
| D2331 |
|
1,176 |
849 |
$5K |
| D9248 |
|
188 |
182 |
$3K |
| D1354 |
|
8,423 |
2,194 |
$3K |
| D1110 |
Prophylaxis - adult |
12,782 |
12,424 |
$3K |
| D4910 |
|
4,045 |
3,919 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,176 |
15,675 |
$2K |
| D7240 |
Removal of impacted tooth - completely bony |
36 |
25 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,880 |
1,549 |
$1K |
| D0273 |
|
151 |
148 |
$709.60 |
| D0270 |
|
4,432 |
4,286 |
$572.50 |
| D0603 |
|
8,500 |
8,306 |
$549.10 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
329 |
228 |
$418.80 |
| D0210 |
Intraoral - complete series of radiographic images |
8,593 |
8,253 |
$351.57 |
| D2940 |
|
54 |
48 |
$308.76 |
| D2332 |
|
276 |
209 |
$296.95 |
| D2335 |
|
227 |
169 |
$206.00 |
| D4342 |
|
845 |
388 |
$118.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
1,398 |
1,378 |
$112.85 |
| D2394 |
|
58 |
56 |
$95.00 |
| D1510 |
|
14 |
13 |
$84.02 |
| D0191 |
|
376 |
351 |
$60.02 |
| D9995 |
|
202 |
179 |
$58.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
214 |
205 |
$51.00 |
| D0602 |
|
2,998 |
2,939 |
$21.25 |
| D0601 |
|
2,234 |
2,190 |
$21.25 |
| D4341 |
|
1,808 |
804 |
$0.00 |
| D9430 |
|
58 |
40 |
$0.00 |
| D3221 |
|
15 |
14 |
$0.00 |
| D1330 |
|
39,548 |
38,023 |
$0.00 |
| D1310 |
|
4,610 |
4,505 |
$0.00 |
| D4355 |
|
27 |
26 |
$0.00 |
| D1320 |
|
560 |
533 |
$0.00 |
| D3120 |
|
370 |
246 |
$0.00 |
| D1353 |
|
142 |
77 |
$0.00 |
| D0171 |
|
39 |
33 |
$0.00 |
| D2160 |
|
44 |
38 |
$0.00 |
| D7510 |
|
32 |
19 |
$0.00 |