| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,600 |
1,426 |
$560K |
| D1120 |
Prophylaxis - child |
12,800 |
11,958 |
$394K |
| D1206 |
Topical application of fluoride varnish |
14,420 |
13,404 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
11,807 |
10,954 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,759 |
1,065 |
$175K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,874 |
1,243 |
$165K |
| D0272 |
Bitewings - two radiographic images |
5,640 |
5,223 |
$117K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,233 |
2,741 |
$85K |
| D1110 |
Prophylaxis - adult |
1,811 |
1,703 |
$80K |
| D1354 |
|
885 |
283 |
$70K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
809 |
378 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,434 |
2,287 |
$67K |
| D0330 |
Panoramic radiographic image |
1,405 |
1,266 |
$58K |
| D0240 |
|
3,924 |
1,893 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
2,086 |
1,515 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,572 |
2,274 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
624 |
548 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,731 |
923 |
$19K |
| D0274 |
Bitewings - four radiographic images |
732 |
645 |
$19K |
| D1351 |
Sealant - per tooth |
762 |
201 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
501 |
459 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
109 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
43 |
$5K |
| D2140 |
|
123 |
69 |
$3K |
| D9248 |
|
42 |
37 |
$1K |