| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,519 |
3,561 |
$1.56M |
| D1351 |
Sealant - per tooth |
56,021 |
10,133 |
$1.39M |
| D0120 |
Periodic oral evaluation - established patient |
50,090 |
49,496 |
$1.39M |
| D1120 |
Prophylaxis - child |
34,392 |
33,991 |
$1.21M |
| D1110 |
Prophylaxis - adult |
17,756 |
17,506 |
$917K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,846 |
5,037 |
$859K |
| D0145 |
Oral evaluation for a patient under three years of age |
5,849 |
5,787 |
$808K |
| D1208 |
Topical application of fluoride, excluding varnish |
49,366 |
48,785 |
$702K |
| D9248 |
|
5,517 |
5,388 |
$621K |
| D0272 |
Bitewings - two radiographic images |
24,933 |
24,520 |
$504K |
| D0274 |
Bitewings - four radiographic images |
16,882 |
16,595 |
$488K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,504 |
2,345 |
$424K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,813 |
2,539 |
$281K |
| D0210 |
Intraoral - complete series of radiographic images |
4,161 |
4,151 |
$278K |
| D7240 |
Removal of impacted tooth - completely bony |
958 |
284 |
$263K |
| D0330 |
Panoramic radiographic image |
9,156 |
8,968 |
$255K |
| D0220 |
Intraoral - periapical first radiographic image |
15,176 |
14,674 |
$157K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,864 |
1,725 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,521 |
3,398 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,078 |
831 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,427 |
3,235 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,549 |
5,781 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,478 |
2,442 |
$45K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
728 |
353 |
$28K |
| D9222 |
|
369 |
364 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,437 |
1,414 |
$20K |
| D9420 |
|
503 |
484 |
$17K |
| D2934 |
|
126 |
38 |
$17K |
| D9612 |
|
344 |
340 |
$9K |
| D0170 |
|
395 |
391 |
$6K |
| D2332 |
|
46 |
28 |
$5K |
| D9310 |
|
225 |
224 |
$2K |
| D0270 |
|
321 |
303 |
$1K |
| D7111 |
|
113 |
85 |
$1K |
| D0367 |
|
12 |
12 |
$1K |
| D0240 |
|
15 |
12 |
$107.80 |
| D0603 |
|
59,950 |
59,457 |
$0.00 |