| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,563 |
3,967 |
$1.34M |
| D1120 |
Prophylaxis - child |
39,375 |
38,479 |
$1.08M |
| D0120 |
Periodic oral evaluation - established patient |
40,993 |
40,202 |
$796K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,797 |
5,062 |
$627K |
| D1351 |
Sealant - per tooth |
21,772 |
7,512 |
$603K |
| D0274 |
Bitewings - four radiographic images |
20,584 |
20,161 |
$585K |
| D1206 |
Topical application of fluoride varnish |
33,965 |
33,278 |
$516K |
| D0272 |
Bitewings - two radiographic images |
23,630 |
23,137 |
$435K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,912 |
3,664 |
$352K |
| D1110 |
Prophylaxis - adult |
9,967 |
9,734 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,031 |
8,783 |
$271K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,534 |
2,711 |
$220K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,835 |
1,557 |
$216K |
| D0220 |
Intraoral - periapical first radiographic image |
16,839 |
16,051 |
$190K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,056 |
8,342 |
$174K |
| D0330 |
Panoramic radiographic image |
3,595 |
3,496 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,148 |
10,947 |
$166K |
| D2932 |
|
1,139 |
488 |
$160K |
| D9420 |
|
1,021 |
667 |
$155K |
| D9410 |
|
299 |
295 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,654 |
9,574 |
$119K |
| D0240 |
|
8,159 |
5,946 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
3,377 |
3,246 |
$79K |
| D9630 |
|
2,865 |
2,763 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
832 |
580 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,264 |
670 |
$76K |
| D9310 |
|
948 |
894 |
$65K |
| D9999 |
Unspecified adjunctive procedure, by report |
134 |
130 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,714 |
1,681 |
$51K |
| D2934 |
|
323 |
105 |
$38K |
| D1510 |
|
256 |
216 |
$35K |
| D2335 |
|
186 |
87 |
$24K |
| D9248 |
|
683 |
642 |
$20K |
| D1354 |
|
956 |
499 |
$11K |
| D2140 |
|
158 |
123 |
$7K |
| D9920 |
|
319 |
298 |
$6K |
| D2330 |
|
104 |
77 |
$6K |
| D1999 |
|
479 |
377 |
$1.59 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$0.00 |