| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,071 |
8,662 |
$2.28M |
| D1120 |
Prophylaxis - child |
48,125 |
47,646 |
$1.61M |
| D0120 |
Periodic oral evaluation - established patient |
54,202 |
53,636 |
$1.32M |
| D1208 |
Topical application of fluoride, excluding varnish |
54,479 |
53,938 |
$1.12M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,232 |
9,913 |
$1.01M |
| D1110 |
Prophylaxis - adult |
13,510 |
13,358 |
$583K |
| D1351 |
Sealant - per tooth |
15,696 |
5,153 |
$485K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16,534 |
15,614 |
$484K |
| D2934 |
|
3,857 |
1,209 |
$459K |
| D9248 |
|
4,762 |
4,620 |
$399K |
| D0330 |
Panoramic radiographic image |
9,024 |
8,940 |
$364K |
| D0272 |
Bitewings - two radiographic images |
20,222 |
20,037 |
$357K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,141 |
11,012 |
$323K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,158 |
10,917 |
$311K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,362 |
2,425 |
$252K |
| D0220 |
Intraoral - periapical first radiographic image |
19,542 |
19,135 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,213 |
2,564 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
3,318 |
3,268 |
$185K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,028 |
1,487 |
$167K |
| D2140 |
|
2,188 |
1,738 |
$136K |
| D0140 |
Limited oral evaluation - problem focused |
4,733 |
4,685 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,591 |
3,561 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,106 |
929 |
$82K |
| D4342 |
|
948 |
391 |
$30K |
| D2160 |
|
283 |
219 |
$24K |
| D2330 |
|
211 |
129 |
$11K |
| D1354 |
|
534 |
189 |
$5K |
| D1353 |
|
135 |
40 |
$3K |
| D1310 |
|
46,245 |
45,616 |
$0.00 |
| D9215 |
|
73 |
72 |
$0.00 |
| D1999 |
|
93 |
92 |
$0.00 |
| D0350 |
|
24 |
24 |
$0.00 |