| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,692 |
924 |
$540K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,992 |
2,679 |
$357K |
| D0120 |
Periodic oral evaluation - established patient |
10,970 |
10,555 |
$327K |
| D1206 |
Topical application of fluoride varnish |
12,030 |
11,571 |
$271K |
| D1120 |
Prophylaxis - child |
10,847 |
10,463 |
$262K |
| D2929 |
|
677 |
83 |
$181K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,568 |
4,408 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,354 |
1,451 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,066 |
2,975 |
$126K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,312 |
4,344 |
$123K |
| D1351 |
Sealant - per tooth |
4,449 |
1,468 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,545 |
824 |
$85K |
| D8670 |
Periodic orthodontic treatment visit |
264 |
252 |
$56K |
| D2390 |
|
222 |
59 |
$55K |
| D0272 |
Bitewings - two radiographic images |
4,656 |
4,438 |
$45K |
| D0330 |
Panoramic radiographic image |
1,308 |
1,264 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
229 |
120 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
973 |
923 |
$22K |
| D1999 |
|
1,674 |
1,366 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,602 |
2,483 |
$21K |
| D1110 |
Prophylaxis - adult |
368 |
363 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
107 |
$12K |
| D0160 |
|
292 |
280 |
$10K |
| D0274 |
Bitewings - four radiographic images |
439 |
432 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,531 |
1,622 |
$6K |