| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,690 |
3,085 |
$1.41M |
| D0120 |
Periodic oral evaluation - established patient |
36,045 |
35,505 |
$949K |
| D1120 |
Prophylaxis - child |
41,172 |
40,434 |
$922K |
| D1206 |
Topical application of fluoride varnish |
38,864 |
38,170 |
$753K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,465 |
4,975 |
$697K |
| D1351 |
Sealant - per tooth |
29,624 |
6,786 |
$683K |
| D9999 |
Unspecified adjunctive procedure, by report |
12,496 |
12,322 |
$369K |
| D0272 |
Bitewings - two radiographic images |
29,474 |
29,008 |
$294K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,571 |
2,123 |
$255K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,509 |
2,573 |
$241K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,781 |
5,584 |
$236K |
| D0330 |
Panoramic radiographic image |
5,703 |
5,629 |
$234K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,797 |
7,996 |
$186K |
| D0240 |
|
10,843 |
5,675 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
3,467 |
3,358 |
$72K |
| D1354 |
|
15,641 |
3,334 |
$52K |
| D1999 |
|
3,704 |
3,390 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
5,218 |
5,032 |
$42K |
| D2332 |
|
426 |
246 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
396 |
208 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
487 |
329 |
$34K |
| D9630 |
|
282 |
276 |
$12K |
| D2330 |
|
97 |
54 |
$7K |
| D1110 |
Prophylaxis - adult |
169 |
167 |
$6K |
| D1510 |
|
61 |
41 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,105 |
788 |
$3K |
| D9992 |
|
35 |
34 |
$525.00 |