| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,992 |
4,944 |
$1.72M |
| D1120 |
Prophylaxis - child |
30,711 |
28,646 |
$1.06M |
| D0120 |
Periodic oral evaluation - established patient |
38,607 |
36,114 |
$993K |
| D1208 |
Topical application of fluoride, excluding varnish |
44,310 |
41,770 |
$856K |
| D0272 |
Bitewings - two radiographic images |
32,466 |
30,852 |
$748K |
| D1110 |
Prophylaxis - adult |
15,572 |
14,828 |
$730K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,599 |
5,566 |
$611K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,439 |
4,270 |
$573K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22,063 |
20,344 |
$548K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,180 |
4,169 |
$492K |
| D2140 |
|
7,770 |
4,654 |
$489K |
| D9248 |
|
5,387 |
5,095 |
$487K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,373 |
4,411 |
$418K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,716 |
2,084 |
$305K |
| D0330 |
Panoramic radiographic image |
4,762 |
4,267 |
$261K |
| D1351 |
Sealant - per tooth |
8,422 |
2,665 |
$222K |
| D1510 |
|
1,479 |
1,117 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
11,894 |
10,998 |
$196K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,621 |
4,982 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,036 |
2,707 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,256 |
1,200 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
2,631 |
2,491 |
$82K |
| D0603 |
|
15,145 |
14,051 |
$67K |
| D2330 |
|
887 |
593 |
$62K |
| D0602 |
|
9,093 |
8,551 |
$40K |
| D0601 |
|
7,225 |
6,436 |
$32K |
| D2331 |
|
301 |
202 |
$26K |
| D2160 |
|
69 |
52 |
$6K |
| D0274 |
Bitewings - four radiographic images |
160 |
160 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
29 |
$3K |
| D7111 |
|
37 |
26 |
$2K |