| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
31,093 |
8,681 |
$2.30M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,639 |
4,607 |
$1.13M |
| D1110 |
Prophylaxis - adult |
14,661 |
13,647 |
$643K |
| D1120 |
Prophylaxis - child |
19,583 |
18,354 |
$596K |
| D1351 |
Sealant - per tooth |
24,843 |
5,714 |
$593K |
| D0120 |
Periodic oral evaluation - established patient |
26,759 |
25,116 |
$548K |
| D1206 |
Topical application of fluoride varnish |
27,755 |
25,941 |
$540K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,424 |
3,526 |
$502K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,291 |
4,055 |
$422K |
| D0274 |
Bitewings - four radiographic images |
15,619 |
14,452 |
$420K |
| D0210 |
Intraoral - complete series of radiographic images |
9,047 |
8,373 |
$369K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,229 |
9,387 |
$334K |
| D0272 |
Bitewings - two radiographic images |
15,541 |
14,563 |
$307K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,155 |
1,977 |
$293K |
| D2140 |
|
5,389 |
3,377 |
$273K |
| D0330 |
Panoramic radiographic image |
7,065 |
6,422 |
$234K |
| D2160 |
|
2,693 |
1,897 |
$225K |
| D2941 |
|
1,700 |
510 |
$211K |
| D9920 |
|
5,106 |
4,248 |
$196K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,092 |
646 |
$182K |
| D4346 |
|
750 |
627 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
3,630 |
3,295 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
3,287 |
3,044 |
$38K |
| D2949 |
|
212 |
187 |
$38K |
| D4355 |
|
461 |
415 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,231 |
1,074 |
$33K |
| D7111 |
|
435 |
290 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,793 |
1,673 |
$24K |
| D2335 |
|
145 |
105 |
$21K |
| D2940 |
|
304 |
252 |
$18K |
| D2931 |
|
103 |
89 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
122 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
85 |
$11K |
| D2330 |
|
121 |
78 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
958 |
445 |
$8K |
| D0160 |
|
42 |
42 |
$3K |
| D1510 |
|
12 |
12 |
$2K |
| D0240 |
|
188 |
167 |
$2K |
| D1999 |
|
1,217 |
997 |
$2K |
| D1352 |
|
17 |
12 |
$795.60 |
| D0277 |
|
21 |
20 |
$581.80 |
| D0191 |
|
188 |
170 |
$0.00 |