| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,556 |
1,514 |
$949K |
| D0120 |
Periodic oral evaluation - established patient |
17,857 |
17,485 |
$457K |
| D1120 |
Prophylaxis - child |
16,159 |
15,813 |
$370K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,162 |
18,730 |
$353K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,210 |
1,885 |
$281K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,084 |
1,420 |
$169K |
| D0272 |
Bitewings - two radiographic images |
14,401 |
14,043 |
$139K |
| D1110 |
Prophylaxis - adult |
3,526 |
3,448 |
$131K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,063 |
3,936 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,224 |
1,018 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,713 |
2,631 |
$108K |
| D1351 |
Sealant - per tooth |
4,363 |
1,057 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
13,183 |
12,763 |
$103K |
| D0330 |
Panoramic radiographic image |
2,656 |
2,591 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
3,282 |
3,001 |
$68K |
| D2390 |
|
187 |
56 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,895 |
11,972 |
$29K |
| D1999 |
|
1,969 |
1,889 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
856 |
795 |
$19K |
| D2330 |
|
53 |
31 |
$4K |