| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9420 |
|
2,280 |
2,206 |
$3.44M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,580 |
1,567 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
2,359 |
2,278 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,326 |
1,595 |
$67K |
| D3240 |
|
2,212 |
1,083 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,865 |
1,817 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,292 |
1,084 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,045 |
1,178 |
$37K |
| D2933 |
|
992 |
340 |
$34K |
| D2330 |
|
1,860 |
944 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,309 |
771 |
$19K |
| D0272 |
Bitewings - two radiographic images |
2,154 |
2,092 |
$17K |
| D2331 |
|
1,031 |
586 |
$14K |
| D2932 |
|
546 |
175 |
$9K |
| D3120 |
|
1,397 |
706 |
$7K |
| D0350 |
|
2,011 |
1,951 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
2,295 |
2,221 |
$6K |
| D2332 |
|
260 |
172 |
$6K |
| D1351 |
Sealant - per tooth |
1,270 |
501 |
$6K |
| D1120 |
Prophylaxis - child |
1,838 |
1,785 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,043 |
1,983 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,743 |
2,202 |
$4K |
| D1330 |
|
2,009 |
1,949 |
$2K |
| D9219 |
|
63 |
56 |
$1K |
| D9996 |
|
2,027 |
1,965 |
$1K |
| D9920 |
|
24 |
24 |
$254.34 |
| D3230 |
|
136 |
70 |
$0.00 |
| D4355 |
|
106 |
99 |
$0.00 |