| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,799 |
3,373 |
$1.31M |
| D1120 |
Prophylaxis - child |
42,357 |
41,077 |
$948K |
| D0120 |
Periodic oral evaluation - established patient |
41,999 |
40,776 |
$802K |
| D1206 |
Topical application of fluoride varnish |
44,514 |
43,273 |
$798K |
| D1351 |
Sealant - per tooth |
21,324 |
6,477 |
$544K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,540 |
4,552 |
$442K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,684 |
4,818 |
$436K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,281 |
3,325 |
$400K |
| D0330 |
Panoramic radiographic image |
6,461 |
6,220 |
$316K |
| D1110 |
Prophylaxis - adult |
7,456 |
7,229 |
$278K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,110 |
8,453 |
$271K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,644 |
8,314 |
$263K |
| D0272 |
Bitewings - two radiographic images |
20,992 |
20,325 |
$239K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,649 |
1,403 |
$143K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,032 |
607 |
$132K |
| D0274 |
Bitewings - four radiographic images |
3,958 |
3,833 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
3,180 |
3,077 |
$76K |
| D7960 |
|
882 |
521 |
$66K |
| D2140 |
|
1,571 |
929 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,897 |
3,643 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
6,113 |
5,914 |
$37K |
| D2330 |
|
531 |
290 |
$27K |
| D0240 |
|
2,640 |
1,020 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
365 |
137 |
$21K |
| D2390 |
|
138 |
54 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
307 |
278 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
101 |
$11K |
| D0350 |
|
856 |
796 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,635 |
1,037 |
$10K |
| D2331 |
|
82 |
55 |
$5K |
| D2934 |
|
33 |
12 |
$5K |
| D1354 |
|
148 |
74 |
$4K |
| D2332 |
|
55 |
29 |
$4K |
| D2335 |
|
28 |
18 |
$3K |
| D0270 |
|
173 |
170 |
$935.00 |
| D9420 |
|
623 |
570 |
$0.00 |