| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34,301 |
8,807 |
$3.92M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29,448 |
7,750 |
$2.46M |
| D1120 |
Prophylaxis - child |
52,838 |
52,154 |
$1.79M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23,372 |
12,937 |
$1.77M |
| D1206 |
Topical application of fluoride varnish |
77,171 |
76,226 |
$1.62M |
| D0120 |
Periodic oral evaluation - established patient |
63,993 |
63,172 |
$1.57M |
| D2140 |
|
19,635 |
11,760 |
$1.24M |
| D1110 |
Prophylaxis - adult |
24,586 |
24,299 |
$1.08M |
| D2740 |
Crown - porcelain/ceramic |
1,802 |
1,240 |
$905K |
| D2933 |
|
5,767 |
2,082 |
$897K |
| D2160 |
|
8,506 |
4,981 |
$733K |
| D0330 |
Panoramic radiographic image |
17,136 |
16,898 |
$712K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,254 |
18,389 |
$564K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,509 |
4,772 |
$546K |
| D0272 |
Bitewings - two radiographic images |
32,037 |
31,516 |
$513K |
| D1351 |
Sealant - per tooth |
16,423 |
5,401 |
$503K |
| D0274 |
Bitewings - four radiographic images |
19,236 |
18,949 |
$471K |
| D1510 |
|
2,288 |
1,740 |
$355K |
| D0220 |
Intraoral - periapical first radiographic image |
25,225 |
24,132 |
$298K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,357 |
9,229 |
$269K |
| D2950 |
|
1,801 |
1,310 |
$212K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
388 |
359 |
$198K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,549 |
12,801 |
$152K |
| D2335 |
|
1,570 |
716 |
$135K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,331 |
5,261 |
$127K |
| D2332 |
|
943 |
573 |
$80K |
| D2161 |
|
771 |
616 |
$71K |
| D2330 |
|
1,174 |
754 |
$70K |
| D2931 |
|
329 |
281 |
$45K |
| D4355 |
|
270 |
269 |
$25K |
| D3310 |
|
75 |
39 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
944 |
920 |
$20K |
| D1353 |
|
629 |
204 |
$17K |
| D1354 |
|
1,321 |
524 |
$13K |
| D2331 |
|
70 |
52 |
$5K |
| D2920 |
|
109 |
94 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
27 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D1330 |
|
59,794 |
59,455 |
$0.00 |
| D0603 |
|
58,451 |
57,814 |
$0.00 |
| D1310 |
|
59,732 |
59,328 |
$0.00 |
| D3120 |
|
43 |
36 |
$0.00 |
| D0602 |
|
19 |
19 |
$0.00 |
| D9986 |
|
469 |
452 |
$0.00 |