| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,096 |
3,347 |
$1.03M |
| D8670 |
Periodic orthodontic treatment visit |
3,398 |
3,282 |
$904K |
| D1120 |
Prophylaxis - child |
26,308 |
25,143 |
$514K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,044 |
29,717 |
$461K |
| D0120 |
Periodic oral evaluation - established patient |
26,954 |
25,874 |
$453K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,833 |
4,413 |
$448K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,155 |
4,965 |
$408K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,575 |
4,861 |
$406K |
| D1351 |
Sealant - per tooth |
14,787 |
4,944 |
$309K |
| D0330 |
Panoramic radiographic image |
5,320 |
5,078 |
$224K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
283 |
265 |
$223K |
| D8030 |
|
2,442 |
2,173 |
$196K |
| D1110 |
Prophylaxis - adult |
5,318 |
5,140 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,518 |
6,161 |
$165K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,007 |
8,770 |
$163K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,458 |
1,359 |
$155K |
| D0272 |
Bitewings - two radiographic images |
13,512 |
12,932 |
$134K |
| D2933 |
|
632 |
175 |
$92K |
| D2335 |
|
927 |
463 |
$87K |
| D8680 |
|
387 |
185 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,627 |
2,474 |
$57K |
| D0340 |
|
967 |
944 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,041 |
1,977 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
6,756 |
6,320 |
$34K |
| D1510 |
|
217 |
178 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
387 |
247 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,095 |
2,455 |
$16K |
| D2140 |
|
392 |
248 |
$16K |
| D0350 |
|
969 |
944 |
$11K |
| D0240 |
|
1,135 |
467 |
$11K |
| D2330 |
|
226 |
157 |
$10K |
| D2331 |
|
184 |
69 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
95 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$5K |
| D1515 |
|
27 |
24 |
$4K |
| D1999 |
|
43 |
37 |
$0.00 |