| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,678 |
1,962 |
$576K |
| D1351 |
Sealant - per tooth |
16,137 |
3,372 |
$428K |
| D1120 |
Prophylaxis - child |
11,416 |
10,933 |
$321K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,845 |
3,068 |
$317K |
| D1206 |
Topical application of fluoride varnish |
14,475 |
13,750 |
$302K |
| D1110 |
Prophylaxis - adult |
6,906 |
6,606 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
14,625 |
14,031 |
$286K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,210 |
7,132 |
$213K |
| D0272 |
Bitewings - two radiographic images |
9,712 |
9,297 |
$183K |
| D2140 |
|
3,615 |
2,527 |
$173K |
| D0274 |
Bitewings - four radiographic images |
6,136 |
5,847 |
$173K |
| D7240 |
Removal of impacted tooth - completely bony |
543 |
160 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
4,075 |
3,785 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,103 |
3,903 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,405 |
880 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
7,130 |
6,753 |
$64K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
666 |
399 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,892 |
5,185 |
$52K |
| D2160 |
|
594 |
454 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,054 |
1,016 |
$29K |
| D0330 |
Panoramic radiographic image |
1,026 |
924 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,093 |
3,060 |
$16K |
| D9920 |
|
281 |
239 |
$8K |
| D1999 |
|
1,371 |
1,121 |
$0.00 |