| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,487 |
2,801 |
$1.44M |
| D0120 |
Periodic oral evaluation - established patient |
51,253 |
49,293 |
$1.38M |
| D1120 |
Prophylaxis - child |
50,283 |
48,292 |
$1.16M |
| D1206 |
Topical application of fluoride varnish |
43,043 |
41,431 |
$913K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,384 |
7,587 |
$903K |
| D1351 |
Sealant - per tooth |
29,109 |
7,449 |
$664K |
| D9999 |
Unspecified adjunctive procedure, by report |
12,031 |
11,625 |
$354K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,652 |
3,236 |
$350K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,085 |
3,647 |
$327K |
| D1110 |
Prophylaxis - adult |
8,299 |
7,975 |
$314K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,609 |
7,217 |
$300K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,275 |
12,278 |
$289K |
| D0272 |
Bitewings - two radiographic images |
19,319 |
18,519 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,577 |
10,998 |
$184K |
| D0330 |
Panoramic radiographic image |
4,440 |
4,272 |
$166K |
| D0140 |
Limited oral evaluation - problem focused |
7,828 |
7,312 |
$163K |
| D0220 |
Intraoral - periapical first radiographic image |
17,054 |
15,720 |
$129K |
| D2929 |
|
404 |
113 |
$110K |
| D0274 |
Bitewings - four radiographic images |
5,481 |
5,233 |
$74K |
| D0240 |
|
8,008 |
4,096 |
$62K |
| D1999 |
|
5,455 |
5,260 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
698 |
498 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,694 |
10,251 |
$45K |
| D7962 |
|
494 |
459 |
$42K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
374 |
154 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
461 |
271 |
$30K |
| D9610 |
|
626 |
602 |
$25K |
| D7961 |
|
248 |
228 |
$21K |
| D2332 |
|
220 |
83 |
$20K |
| D2390 |
|
98 |
36 |
$17K |
| D2331 |
|
76 |
50 |
$7K |
| D9630 |
|
182 |
134 |
$6K |
| D9248 |
|
69 |
65 |
$4K |
| D9920 |
|
133 |
123 |
$3K |
| D3230 |
|
44 |
12 |
$3K |
| D1354 |
|
852 |
271 |
$3K |
| D2140 |
|
43 |
29 |
$2K |
| D9110 |
|
36 |
33 |
$1K |
| D3120 |
|
311 |
232 |
$0.00 |
| D0602 |
|
514 |
513 |
$0.00 |
| D0603 |
|
2,492 |
2,481 |
$0.00 |
| D1330 |
|
513 |
502 |
$0.00 |
| D0601 |
|
1,612 |
1,594 |
$0.00 |