| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,422 |
1,625 |
$622K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,071 |
3,926 |
$484K |
| D0120 |
Periodic oral evaluation - established patient |
15,332 |
14,463 |
$423K |
| D1120 |
Prophylaxis - child |
17,487 |
16,454 |
$405K |
| D1206 |
Topical application of fluoride varnish |
18,993 |
17,867 |
$390K |
| D2929 |
|
872 |
105 |
$239K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,587 |
2,287 |
$197K |
| D1351 |
Sealant - per tooth |
8,055 |
2,510 |
$177K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,758 |
5,416 |
$175K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,994 |
6,634 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,394 |
4,113 |
$170K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,985 |
1,495 |
$169K |
| D2390 |
|
393 |
120 |
$83K |
| D0272 |
Bitewings - two radiographic images |
6,977 |
6,546 |
$67K |
| D0330 |
Panoramic radiographic image |
1,694 |
1,605 |
$54K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
641 |
300 |
$49K |
| D8670 |
Periodic orthodontic treatment visit |
221 |
210 |
$47K |
| D1110 |
Prophylaxis - adult |
1,197 |
1,132 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,187 |
4,834 |
$41K |
| D1999 |
|
3,292 |
2,489 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,431 |
1,338 |
$30K |
| D0160 |
|
700 |
667 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,279 |
1,184 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,850 |
3,420 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
86 |
$8K |
| D2330 |
|
20 |
13 |
$1K |