| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48,734 |
16,345 |
$6.35M |
| D1120 |
Prophylaxis - child |
93,531 |
88,762 |
$3.17M |
| D0120 |
Periodic oral evaluation - established patient |
91,017 |
86,348 |
$2.42M |
| D1351 |
Sealant - per tooth |
60,522 |
17,125 |
$1.65M |
| D7140 |
Extraction, erupted tooth or exposed root |
21,512 |
11,107 |
$1.52M |
| D1208 |
Topical application of fluoride, excluding varnish |
76,369 |
72,213 |
$1.47M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,162 |
10,629 |
$1.39M |
| D1110 |
Prophylaxis - adult |
27,674 |
26,107 |
$1.30M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12,263 |
6,315 |
$1.13M |
| D0272 |
Bitewings - two radiographic images |
53,631 |
50,767 |
$1.06M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30,534 |
27,892 |
$1.05M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,194 |
10,674 |
$1.04M |
| D1206 |
Topical application of fluoride varnish |
39,881 |
37,805 |
$947K |
| D0330 |
Panoramic radiographic image |
16,902 |
16,226 |
$923K |
| D9248 |
|
7,946 |
7,232 |
$906K |
| D2934 |
|
3,984 |
1,286 |
$800K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,618 |
15,585 |
$770K |
| D0210 |
Intraoral - complete series of radiographic images |
12,747 |
11,801 |
$701K |
| D0145 |
Oral evaluation for a patient under three years of age |
13,311 |
12,590 |
$618K |
| D0220 |
Intraoral - periapical first radiographic image |
44,697 |
41,435 |
$598K |
| D9420 |
|
4,488 |
4,278 |
$419K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,269 |
17,732 |
$387K |
| D0140 |
Limited oral evaluation - problem focused |
15,139 |
13,993 |
$196K |
| D2330 |
|
1,052 |
749 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
223 |
$31K |
| D2929 |
|
109 |
33 |
$26K |
| D7111 |
|
189 |
135 |
$14K |
| D2931 |
|
47 |
42 |
$12K |
| D2390 |
|
58 |
24 |
$9K |
| D1510 |
|
29 |
25 |
$4K |
| D2335 |
|
16 |
13 |
$3K |
| D2140 |
|
38 |
30 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
17 |
$2K |
| D2332 |
|
15 |
12 |
$1K |
| D3120 |
|
50 |
44 |
$0.00 |