| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,814 |
1,235 |
$458K |
| D1120 |
Prophylaxis - child |
13,460 |
13,362 |
$370K |
| D1206 |
Topical application of fluoride varnish |
16,223 |
16,103 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
14,066 |
13,961 |
$227K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,338 |
1,544 |
$175K |
| D1351 |
Sealant - per tooth |
6,318 |
1,772 |
$166K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,089 |
1,261 |
$119K |
| D1110 |
Prophylaxis - adult |
3,298 |
3,274 |
$117K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,582 |
3,425 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,361 |
998 |
$90K |
| D9630 |
|
4,996 |
4,959 |
$87K |
| D0272 |
Bitewings - two radiographic images |
5,055 |
5,018 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,825 |
2,801 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,991 |
1,925 |
$70K |
| D9999 |
Unspecified adjunctive procedure, by report |
452 |
443 |
$60K |
| D9310 |
|
724 |
718 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,046 |
2,026 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,930 |
1,887 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,182 |
4,038 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,143 |
1,993 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
479 |
260 |
$34K |
| D3120 |
|
340 |
98 |
$4K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$2K |