| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
29,881 |
6,417 |
$1.90M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,023 |
3,980 |
$1.60M |
| D1351 |
Sealant - per tooth |
35,197 |
10,327 |
$749K |
| D1120 |
Prophylaxis - child |
27,887 |
25,999 |
$704K |
| D1206 |
Topical application of fluoride varnish |
40,541 |
37,725 |
$676K |
| D0120 |
Periodic oral evaluation - established patient |
37,308 |
34,765 |
$641K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,980 |
4,067 |
$547K |
| D1110 |
Prophylaxis - adult |
12,417 |
11,553 |
$461K |
| D0240 |
|
31,763 |
14,353 |
$424K |
| D2140 |
|
8,833 |
5,270 |
$381K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,372 |
12,946 |
$348K |
| D0272 |
Bitewings - two radiographic images |
14,110 |
13,046 |
$260K |
| D0330 |
Panoramic radiographic image |
5,186 |
4,820 |
$240K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,410 |
2,298 |
$183K |
| D0274 |
Bitewings - four radiographic images |
5,447 |
5,027 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,176 |
3,843 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
920 |
621 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,287 |
2,547 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
5,207 |
4,673 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
3,153 |
2,274 |
$38K |
| D2330 |
|
682 |
441 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,369 |
1,274 |
$31K |
| D2390 |
|
242 |
81 |
$27K |
| D1517 |
|
76 |
58 |
$18K |
| D1510 |
|
98 |
51 |
$12K |
| D1515 |
|
341 |
287 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
423 |
390 |
$10K |
| D1352 |
|
168 |
99 |
$6K |
| D1516 |
|
21 |
12 |
$4K |
| D7111 |
|
53 |
36 |
$3K |
| D1999 |
|
34,759 |
28,434 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
15 |
$1K |
| D2332 |
|
82 |
39 |
$111.58 |
| D1550 |
|
20 |
16 |
$36.50 |