| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
88,391 |
21,609 |
$11.68M |
| D0145 |
Oral evaluation for a patient under three years of age |
53,373 |
52,145 |
$7.04M |
| D1351 |
Sealant - per tooth |
259,951 |
58,479 |
$6.55M |
| D1120 |
Prophylaxis - child |
175,654 |
171,200 |
$5.98M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62,042 |
33,996 |
$5.80M |
| D0120 |
Periodic oral evaluation - established patient |
209,556 |
204,355 |
$5.67M |
| D0272 |
Bitewings - two radiographic images |
156,322 |
151,940 |
$3.19M |
| D1206 |
Topical application of fluoride varnish |
214,135 |
209,342 |
$2.95M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39,706 |
24,982 |
$2.86M |
| D1110 |
Prophylaxis - adult |
55,488 |
54,264 |
$2.81M |
| D0230 |
Intraoral - periapical each additional radiographic image |
288,708 |
218,735 |
$2.77M |
| D0220 |
Intraoral - periapical first radiographic image |
249,196 |
238,757 |
$2.69M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34,491 |
9,407 |
$2.65M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66,172 |
62,987 |
$1.61M |
| D0274 |
Bitewings - four radiographic images |
52,464 |
51,260 |
$1.52M |
| D2934 |
|
9,791 |
2,696 |
$1.25M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33,207 |
32,022 |
$1.06M |
| D7140 |
Extraction, erupted tooth or exposed root |
18,662 |
9,874 |
$958K |
| D9248 |
|
9,313 |
9,072 |
$948K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,682 |
1,579 |
$936K |
| D7240 |
Removal of impacted tooth - completely bony |
3,442 |
989 |
$908K |
| D0210 |
Intraoral - complete series of radiographic images |
13,274 |
13,159 |
$843K |
| D0330 |
Panoramic radiographic image |
32,703 |
32,014 |
$571K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
11,260 |
4,605 |
$453K |
| D0140 |
Limited oral evaluation - problem focused |
16,431 |
16,068 |
$284K |
| D9222 |
|
4,804 |
4,647 |
$267K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,489 |
15,737 |
$215K |
| D2931 |
|
1,109 |
1,014 |
$162K |
| D2330 |
|
1,694 |
753 |
$114K |
| D2950 |
|
2,363 |
2,097 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
888 |
657 |
$87K |
| D1510 |
|
527 |
402 |
$75K |
| D0160 |
|
5,124 |
5,062 |
$70K |
| D9420 |
|
1,611 |
1,554 |
$53K |
| D3310 |
|
87 |
67 |
$29K |
| D7111 |
|
2,308 |
1,467 |
$24K |
| D2332 |
|
189 |
106 |
$22K |
| D0270 |
|
4,767 |
4,630 |
$21K |
| D7230 |
|
110 |
54 |
$17K |
| D0170 |
|
473 |
459 |
$7K |
| D2335 |
|
43 |
26 |
$6K |
| D3320 |
|
13 |
12 |
$5K |
| D9310 |
|
460 |
452 |
$5K |
| D9612 |
|
57 |
56 |
$2K |
| D1354 |
|
112 |
37 |
$1K |
| D3120 |
|
1,038 |
806 |
$974.78 |
| D0460 |
|
86 |
86 |
$967.75 |
| D0273 |
|
24 |
23 |
$174.06 |
| D2920 |
|
16 |
15 |
$152.88 |
| D0603 |
|
306,915 |
299,945 |
$0.13 |
| D9986 |
|
752 |
731 |
$0.00 |
| D0602 |
|
759 |
752 |
$0.00 |
| D0601 |
|
419 |
396 |
$0.00 |