| Code | Description | Claims | Beneficiaries | Total Paid |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,129 |
6,120 |
$1.47M |
| D1351 |
Sealant - per tooth |
54,414 |
12,096 |
$1.34M |
| D1120 |
Prophylaxis - child |
39,116 |
36,770 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
43,300 |
40,921 |
$795K |
| D1110 |
Prophylaxis - adult |
18,882 |
17,892 |
$748K |
| D1206 |
Topical application of fluoride varnish |
37,175 |
34,801 |
$666K |
| D7240 |
Removal of impacted tooth - completely bony |
1,938 |
596 |
$610K |
| D0272 |
Bitewings - two radiographic images |
27,411 |
25,726 |
$505K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,667 |
17,955 |
$504K |
| D0210 |
Intraoral - complete series of radiographic images |
12,664 |
11,736 |
$465K |
| D2140 |
|
9,862 |
6,649 |
$460K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,084 |
15,079 |
$417K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,665 |
4,482 |
$412K |
| D0274 |
Bitewings - four radiographic images |
14,678 |
13,859 |
$381K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,352 |
3,404 |
$342K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,011 |
877 |
$339K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,744 |
18,883 |
$299K |
| D0330 |
Panoramic radiographic image |
8,939 |
8,253 |
$236K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,806 |
1,713 |
$233K |
| D0220 |
Intraoral - periapical first radiographic image |
23,312 |
21,676 |
$196K |
| D0140 |
Limited oral evaluation - problem focused |
5,726 |
5,308 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,815 |
15,718 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,790 |
1,277 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,569 |
1,703 |
$121K |
| D2160 |
|
1,219 |
918 |
$94K |
| D7111 |
|
1,232 |
772 |
$71K |
| D2332 |
|
418 |
275 |
$42K |
| D2330 |
|
695 |
489 |
$38K |
| D2335 |
|
299 |
200 |
$33K |
| D9920 |
|
1,563 |
1,255 |
$32K |
| D7230 |
|
67 |
42 |
$18K |
| D7250 |
|
71 |
24 |
$17K |
| D2331 |
|
146 |
107 |
$11K |
| D4346 |
|
48 |
48 |
$9K |
| D2934 |
|
46 |
25 |
$7K |
| D1999 |
|
13,444 |
10,927 |
$5K |
| D0270 |
|
206 |
195 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |