| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32,032 |
9,089 |
$4.12M |
| D0120 |
Periodic oral evaluation - established patient |
98,001 |
94,162 |
$2.39M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23,226 |
8,198 |
$1.99M |
| D1120 |
Prophylaxis - child |
60,210 |
58,041 |
$1.96M |
| D1110 |
Prophylaxis - adult |
39,007 |
37,364 |
$1.81M |
| D1208 |
Topical application of fluoride, excluding varnish |
97,940 |
94,144 |
$1.77M |
| D0272 |
Bitewings - two radiographic images |
67,916 |
64,969 |
$1.49M |
| D1351 |
Sealant - per tooth |
28,671 |
6,932 |
$755K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,711 |
5,235 |
$609K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,185 |
17,226 |
$461K |
| D0210 |
Intraoral - complete series of radiographic images |
4,983 |
4,696 |
$404K |
| D0220 |
Intraoral - periapical first radiographic image |
21,833 |
21,009 |
$349K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,644 |
2,793 |
$311K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,475 |
3,245 |
$263K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,225 |
11,725 |
$259K |
| D2934 |
|
1,538 |
440 |
$203K |
| D0140 |
Limited oral evaluation - problem focused |
6,296 |
6,027 |
$197K |
| D0330 |
Panoramic radiographic image |
4,567 |
4,526 |
$139K |
| D2140 |
|
1,889 |
1,288 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,400 |
989 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
993 |
986 |
$31K |
| D9310 |
|
77 |
76 |
$4K |
| D7111 |
|
53 |
26 |
$2K |
| D0603 |
|
392 |
390 |
$0.00 |