| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,010 |
606 |
$291K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,977 |
1,624 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
6,994 |
6,898 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,974 |
1,604 |
$175K |
| D1120 |
Prophylaxis - child |
7,320 |
7,175 |
$170K |
| D1351 |
Sealant - per tooth |
7,442 |
1,726 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,660 |
2,573 |
$98K |
| D1206 |
Topical application of fluoride varnish |
3,849 |
3,806 |
$90K |
| D1110 |
Prophylaxis - adult |
2,220 |
2,189 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,490 |
3,291 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,121 |
4,040 |
$72K |
| D0330 |
Panoramic radiographic image |
1,994 |
1,942 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
8,156 |
7,871 |
$65K |
| D0272 |
Bitewings - two radiographic images |
6,150 |
6,049 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,697 |
8,447 |
$42K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,101 |
1,087 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
986 |
962 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
361 |
192 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
128 |
54 |
$12K |
| D9630 |
|
237 |
234 |
$10K |
| D1999 |
|
696 |
641 |
$9K |
| D9248 |
|
123 |
121 |
$7K |
| D2331 |
|
32 |
27 |
$4K |
| D2330 |
|
22 |
12 |
$1K |
| D0160 |
|
15 |
15 |
$518.16 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$172.50 |