| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,852 |
1,640 |
$893K |
| D1120 |
Prophylaxis - child |
16,706 |
16,542 |
$842K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,691 |
3,537 |
$832K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,154 |
2,523 |
$470K |
| D1206 |
Topical application of fluoride varnish |
17,717 |
17,539 |
$451K |
| D0120 |
Periodic oral evaluation - established patient |
15,064 |
14,933 |
$447K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,155 |
2,617 |
$372K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,153 |
5,096 |
$299K |
| D1351 |
Sealant - per tooth |
6,958 |
2,362 |
$265K |
| D0140 |
Limited oral evaluation - problem focused |
5,661 |
5,478 |
$242K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,373 |
1,068 |
$230K |
| D0272 |
Bitewings - two radiographic images |
7,057 |
6,900 |
$214K |
| D0330 |
Panoramic radiographic image |
2,366 |
2,344 |
$186K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,063 |
7,941 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
8,203 |
7,714 |
$151K |
| D9110 |
|
1,834 |
1,768 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,583 |
5,148 |
$114K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,027 |
537 |
$88K |
| D0274 |
Bitewings - four radiographic images |
1,931 |
1,912 |
$86K |
| D2140 |
|
1,204 |
534 |
$86K |
| D9920 |
|
1,202 |
1,151 |
$84K |
| D1510 |
|
385 |
282 |
$81K |
| D1110 |
Prophylaxis - adult |
1,183 |
1,168 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,182 |
3,129 |
$76K |
| D2335 |
|
217 |
106 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
159 |
151 |
$33K |
| D2330 |
|
277 |
185 |
$24K |
| D7961 |
|
41 |
41 |
$14K |
| D2331 |
|
114 |
79 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
82 |
$11K |
| D2332 |
|
24 |
13 |
$4K |
| D8660 |
|
14 |
14 |
$2K |
| D9310 |
|
56 |
41 |
$1K |
| D9420 |
|
675 |
631 |
$0.00 |
| D9995 |
|
68 |
65 |
$0.00 |
| D0340 |
|
26 |
24 |
$0.00 |