| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,950 |
3,682 |
$999K |
| D0120 |
Periodic oral evaluation - established patient |
36,815 |
36,049 |
$962K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,093 |
15,370 |
$763K |
| D2140 |
|
9,749 |
5,774 |
$728K |
| D1120 |
Prophylaxis - child |
25,599 |
25,077 |
$701K |
| D1110 |
Prophylaxis - adult |
15,926 |
15,503 |
$610K |
| D1206 |
Topical application of fluoride varnish |
37,039 |
36,146 |
$607K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,356 |
2,960 |
$414K |
| D1351 |
Sealant - per tooth |
15,240 |
4,650 |
$404K |
| D0220 |
Intraoral - periapical first radiographic image |
23,255 |
22,565 |
$350K |
| D0274 |
Bitewings - four radiographic images |
8,740 |
8,503 |
$276K |
| D0330 |
Panoramic radiographic image |
5,449 |
5,322 |
$253K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,663 |
2,436 |
$235K |
| D0272 |
Bitewings - two radiographic images |
11,066 |
10,855 |
$200K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,926 |
1,137 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,556 |
3,451 |
$156K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,671 |
9,879 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,623 |
1,035 |
$129K |
| D2934 |
|
497 |
264 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
877 |
590 |
$91K |
| D2160 |
|
676 |
476 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,885 |
1,821 |
$70K |
| D2332 |
|
677 |
450 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,166 |
4,111 |
$64K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,485 |
780 |
$29K |
| D2330 |
|
370 |
244 |
$24K |
| D1510 |
|
98 |
86 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
97 |
$15K |
| D0350 |
|
16,192 |
15,003 |
$3K |
| D1354 |
|
296 |
101 |
$2K |
| D2331 |
|
19 |
13 |
$2K |
| D1355 |
|
41 |
21 |
$60.50 |
| D0270 |
|
12 |
12 |
$23.74 |
| D1999 |
|
98 |
98 |
$0.00 |