| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34,539 |
11,257 |
$5.08M |
| D7140 |
Extraction, erupted tooth or exposed root |
20,420 |
8,871 |
$1.63M |
| D1120 |
Prophylaxis - child |
57,454 |
54,828 |
$1.55M |
| D1208 |
Topical application of fluoride, excluding varnish |
58,678 |
56,034 |
$1.20M |
| D0120 |
Periodic oral evaluation - established patient |
45,439 |
43,589 |
$1.06M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,682 |
7,621 |
$804K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18,694 |
17,677 |
$675K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,072 |
6,014 |
$665K |
| D2390 |
|
4,137 |
1,665 |
$651K |
| D1351 |
Sealant - per tooth |
22,159 |
6,902 |
$643K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,574 |
17,184 |
$607K |
| D0272 |
Bitewings - two radiographic images |
32,645 |
31,130 |
$436K |
| D0240 |
|
28,597 |
19,595 |
$424K |
| D0330 |
Panoramic radiographic image |
5,303 |
5,045 |
$330K |
| D0140 |
Limited oral evaluation - problem focused |
7,228 |
6,821 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,201 |
11,145 |
$195K |
| D0220 |
Intraoral - periapical first radiographic image |
25,941 |
24,548 |
$179K |
| D1110 |
Prophylaxis - adult |
2,480 |
2,430 |
$96K |
| D1510 |
|
453 |
295 |
$74K |
| D2330 |
|
832 |
531 |
$57K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
385 |
215 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,244 |
1,241 |
$22K |
| D2140 |
|
427 |
285 |
$19K |
| D2335 |
|
148 |
80 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
231 |
160 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
119 |
52 |
$8K |
| D1354 |
|
431 |
167 |
$6K |
| D0270 |
|
1,162 |
1,117 |
$6K |
| D0274 |
Bitewings - four radiographic images |
198 |
196 |
$5K |
| D2331 |
|
28 |
24 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
141 |
$3K |
| D7960 |
|
18 |
14 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
25 |
$2K |
| D9420 |
|
548 |
539 |
$0.00 |
| D0170 |
|
167 |
163 |
$0.00 |
| D2920 |
|
39 |
37 |
$0.00 |
| D1999 |
|
1,102 |
1,047 |
$0.00 |