| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,031 |
2,258 |
$1.57M |
| D1120 |
Prophylaxis - child |
37,746 |
34,260 |
$1.26M |
| D1206 |
Topical application of fluoride varnish |
51,504 |
45,599 |
$1.02M |
| D0120 |
Periodic oral evaluation - established patient |
34,662 |
31,582 |
$846K |
| D1310 |
|
19,567 |
17,337 |
$700K |
| D1351 |
Sealant - per tooth |
26,521 |
4,554 |
$642K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,523 |
2,447 |
$448K |
| D1330 |
|
19,566 |
17,340 |
$411K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,273 |
1,099 |
$383K |
| D1110 |
Prophylaxis - adult |
7,614 |
6,868 |
$351K |
| D0272 |
Bitewings - two radiographic images |
14,839 |
13,446 |
$308K |
| D0330 |
Panoramic radiographic image |
5,662 |
5,048 |
$298K |
| D9630 |
|
19,076 |
17,268 |
$291K |
| D0145 |
Oral evaluation for a patient under three years of age |
7,128 |
6,401 |
$230K |
| D0603 |
|
20,474 |
18,586 |
$191K |
| D0240 |
|
6,181 |
3,058 |
$113K |
| D0425 |
|
2,604 |
2,345 |
$100K |
| D2929 |
|
519 |
117 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,513 |
2,221 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,297 |
613 |
$82K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
907 |
336 |
$81K |
| D1320 |
|
2,929 |
2,100 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,389 |
2,115 |
$77K |
| D9248 |
|
447 |
401 |
$65K |
| D8670 |
Periodic orthodontic treatment visit |
1,596 |
1,039 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,818 |
1,614 |
$57K |
| D9420 |
|
546 |
503 |
$38K |
| D8070 |
|
50 |
39 |
$28K |
| D9310 |
|
266 |
245 |
$14K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
27 |
16 |
$13K |
| D8030 |
|
35 |
20 |
$10K |
| D0350 |
|
298 |
269 |
$10K |
| D0470 |
|
217 |
182 |
$8K |
| D9992 |
|
194 |
176 |
$6K |
| D1354 |
|
240 |
100 |
$5K |
| D0601 |
|
224 |
216 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
75 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
55 |
46 |
$1K |