| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3240 |
|
2,614 |
1,299 |
$384K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,199 |
1,519 |
$304K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,497 |
2,244 |
$295K |
| D1120 |
Prophylaxis - child |
10,247 |
9,937 |
$271K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,465 |
2,406 |
$257K |
| D0120 |
Periodic oral evaluation - established patient |
13,403 |
13,000 |
$236K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,504 |
13,065 |
$188K |
| D1999 |
|
9,684 |
7,899 |
$185K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,786 |
6,176 |
$139K |
| D0330 |
Panoramic radiographic image |
2,461 |
2,377 |
$111K |
| D2140 |
|
2,414 |
1,765 |
$110K |
| D1110 |
Prophylaxis - adult |
3,018 |
2,936 |
$102K |
| D1351 |
Sealant - per tooth |
4,153 |
1,568 |
$99K |
| D0272 |
Bitewings - two radiographic images |
5,654 |
5,449 |
$94K |
| D1206 |
Topical application of fluoride varnish |
4,356 |
4,226 |
$83K |
| D3120 |
|
3,162 |
1,839 |
$73K |
| D0240 |
|
2,321 |
1,432 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
991 |
953 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,963 |
1,906 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
765 |
738 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
166 |
98 |
$13K |
| D1515 |
|
35 |
32 |
$8K |
| D0274 |
Bitewings - four radiographic images |
234 |
223 |
$5K |
| D2160 |
|
67 |
54 |
$4K |
| D3230 |
|
30 |
12 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
159 |
144 |
$1K |