| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,400 |
6,693 |
$2.56M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22,886 |
9,753 |
$2.00M |
| D1120 |
Prophylaxis - child |
47,965 |
47,174 |
$1.56M |
| D0120 |
Periodic oral evaluation - established patient |
58,726 |
57,735 |
$1.50M |
| D0145 |
Oral evaluation for a patient under three years of age |
9,768 |
9,594 |
$1.25M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,547 |
7,750 |
$1.04M |
| D1206 |
Topical application of fluoride varnish |
65,018 |
63,939 |
$887K |
| D2934 |
|
6,053 |
1,692 |
$826K |
| D1110 |
Prophylaxis - adult |
15,784 |
15,516 |
$762K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74,265 |
30,395 |
$701K |
| D1351 |
Sealant - per tooth |
24,720 |
5,521 |
$628K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,554 |
4,742 |
$517K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20,060 |
19,390 |
$489K |
| D0220 |
Intraoral - periapical first radiographic image |
37,375 |
36,217 |
$387K |
| D0272 |
Bitewings - two radiographic images |
19,332 |
18,992 |
$372K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,112 |
2,013 |
$319K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,685 |
9,472 |
$306K |
| D0330 |
Panoramic radiographic image |
7,929 |
7,816 |
$263K |
| D7240 |
Removal of impacted tooth - completely bony |
1,102 |
359 |
$258K |
| D0274 |
Bitewings - four radiographic images |
8,572 |
8,409 |
$240K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,612 |
943 |
$150K |
| D9420 |
|
3,143 |
3,090 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
1,492 |
1,487 |
$94K |
| D2332 |
|
741 |
424 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
4,636 |
4,534 |
$80K |
| D9222 |
|
353 |
346 |
$17K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
468 |
357 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,053 |
1,051 |
$14K |
| D0602 |
|
37,211 |
36,533 |
$14K |
| D2330 |
|
178 |
127 |
$12K |
| D0603 |
|
34,785 |
34,065 |
$9K |
| D2335 |
|
78 |
38 |
$8K |
| D9612 |
|
118 |
116 |
$4K |
| D9610 |
|
183 |
180 |
$3K |
| D7111 |
|
159 |
106 |
$2K |
| D0601 |
|
590 |
586 |
$157.81 |
| D3120 |
|
18 |
15 |
$30.50 |