| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,047 |
4,027 |
$1.80M |
| D1120 |
Prophylaxis - child |
53,037 |
49,303 |
$1.75M |
| D0120 |
Periodic oral evaluation - established patient |
75,412 |
70,102 |
$1.68M |
| D1110 |
Prophylaxis - adult |
34,395 |
31,813 |
$1.60M |
| D1206 |
Topical application of fluoride varnish |
73,630 |
68,321 |
$1.56M |
| D1351 |
Sealant - per tooth |
43,053 |
12,675 |
$1.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,485 |
7,277 |
$775K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,334 |
4,576 |
$624K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,139 |
7,406 |
$616K |
| D0330 |
Panoramic radiographic image |
11,952 |
10,914 |
$610K |
| D0272 |
Bitewings - two radiographic images |
21,297 |
19,787 |
$485K |
| D0274 |
Bitewings - four radiographic images |
13,861 |
12,733 |
$450K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,371 |
10,450 |
$396K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,176 |
10,815 |
$350K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,609 |
1,721 |
$340K |
| D0140 |
Limited oral evaluation - problem focused |
9,148 |
8,173 |
$295K |
| D2330 |
|
3,234 |
2,058 |
$224K |
| D2331 |
|
2,253 |
1,449 |
$195K |
| D2332 |
|
1,408 |
894 |
$130K |
| D0210 |
Intraoral - complete series of radiographic images |
3,399 |
2,902 |
$130K |
| D1510 |
|
836 |
596 |
$129K |
| D2934 |
|
881 |
223 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
11,393 |
9,772 |
$117K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,362 |
1,141 |
$117K |
| D2335 |
|
908 |
610 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,332 |
4,198 |
$96K |
| D1354 |
|
979 |
203 |
$49K |
| D7111 |
|
531 |
366 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
560 |
293 |
$36K |
| D0240 |
|
463 |
312 |
$8K |
| D0270 |
|
438 |
417 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
303 |
276 |
$6K |
| D2920 |
|
29 |
24 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$319.50 |
| D9215 |
|
487 |
461 |
$0.00 |
| D9420 |
|
49 |
48 |
$0.00 |
| D1353 |
|
116 |
36 |
$0.00 |
| D3120 |
|
17 |
14 |
$0.00 |
| D3110 |
|
39 |
26 |
$0.00 |