| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,476 |
7,842 |
$2.83M |
| D0120 |
Periodic oral evaluation - established patient |
87,318 |
85,524 |
$2.28M |
| D1120 |
Prophylaxis - child |
60,095 |
58,664 |
$1.64M |
| D2140 |
|
20,905 |
12,234 |
$1.49M |
| D1110 |
Prophylaxis - adult |
38,351 |
37,444 |
$1.47M |
| D1206 |
Topical application of fluoride varnish |
81,534 |
79,453 |
$1.34M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16,096 |
5,244 |
$1.32M |
| D2934 |
|
5,711 |
1,991 |
$1.09M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
11,096 |
6,863 |
$1.04M |
| D1351 |
Sealant - per tooth |
32,782 |
8,443 |
$905K |
| D0220 |
Intraoral - periapical first radiographic image |
57,574 |
56,177 |
$870K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,641 |
6,235 |
$680K |
| D0274 |
Bitewings - four radiographic images |
24,210 |
23,572 |
$665K |
| D0330 |
Panoramic radiographic image |
13,043 |
12,693 |
$650K |
| D9243 |
|
4,002 |
1,086 |
$546K |
| D0272 |
Bitewings - two radiographic images |
25,968 |
25,442 |
$477K |
| D7230 |
|
2,189 |
789 |
$362K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,847 |
24,876 |
$348K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,816 |
7,530 |
$342K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,561 |
15,318 |
$245K |
| D7240 |
Removal of impacted tooth - completely bony |
1,183 |
435 |
$235K |
| D2160 |
|
1,907 |
1,325 |
$211K |
| D1510 |
|
810 |
659 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,508 |
844 |
$148K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,254 |
3,014 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,696 |
1,076 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
3,421 |
3,330 |
$128K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,924 |
2,317 |
$86K |
| D9239 |
|
1,109 |
1,084 |
$81K |
| D7111 |
|
1,577 |
1,145 |
$80K |
| D3230 |
|
484 |
133 |
$67K |
| D9610 |
|
1,095 |
1,079 |
$39K |
| D9420 |
|
170 |
160 |
$20K |
| D2331 |
|
192 |
108 |
$13K |
| D2330 |
|
176 |
126 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
53 |
$9K |
| D2332 |
|
53 |
24 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$2K |
| D2335 |
|
14 |
12 |
$2K |
| D9440 |
|
14 |
14 |
$893.94 |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
14 |
$323.40 |
| D1354 |
|
36 |
13 |
$254.01 |
| D0350 |
|
4,068 |
3,925 |
$234.00 |
| D1999 |
|
280 |
273 |
$0.00 |