| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,321 |
4,057 |
$2.05M |
| D1120 |
Prophylaxis - child |
54,741 |
49,469 |
$1.81M |
| D1206 |
Topical application of fluoride varnish |
79,164 |
69,726 |
$1.55M |
| D0120 |
Periodic oral evaluation - established patient |
49,064 |
44,501 |
$1.18M |
| D1310 |
|
27,140 |
24,564 |
$997K |
| D1351 |
Sealant - per tooth |
39,346 |
7,309 |
$927K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,176 |
4,298 |
$693K |
| D1330 |
|
27,142 |
24,563 |
$584K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,421 |
1,937 |
$542K |
| D9630 |
|
33,086 |
30,033 |
$521K |
| D0272 |
Bitewings - two radiographic images |
24,369 |
21,978 |
$498K |
| D0330 |
Panoramic radiographic image |
8,824 |
7,874 |
$461K |
| D1110 |
Prophylaxis - adult |
9,274 |
8,299 |
$431K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,209 |
2,603 |
$327K |
| D0603 |
|
34,247 |
31,167 |
$324K |
| D0145 |
Oral evaluation for a patient under three years of age |
9,128 |
8,324 |
$297K |
| D8670 |
Periodic orthodontic treatment visit |
3,154 |
1,950 |
$188K |
| D0240 |
|
9,911 |
4,704 |
$183K |
| D0425 |
|
4,142 |
3,776 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,590 |
4,138 |
$150K |
| D9248 |
|
957 |
860 |
$137K |
| D8070 |
|
54 |
33 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
4,019 |
3,582 |
$126K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,359 |
547 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,387 |
2,993 |
$111K |
| D9310 |
|
1,073 |
949 |
$52K |
| D2929 |
|
280 |
75 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,091 |
2,753 |
$50K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
24 |
13 |
$37K |
| D1320 |
|
884 |
786 |
$31K |
| D9992 |
|
571 |
536 |
$19K |
| D8030 |
|
25 |
12 |
$15K |
| D9420 |
|
225 |
180 |
$14K |
| D0350 |
|
441 |
316 |
$10K |
| D0470 |
|
234 |
175 |
$7K |
| D2332 |
|
23 |
14 |
$3K |
| D1510 |
|
16 |
14 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
46 |
39 |
$1K |
| D1354 |
|
40 |
13 |
$715.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
15 |
$266.01 |