| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,934 |
5,491 |
$1.01M |
| D1120 |
Prophylaxis - child |
36,974 |
34,555 |
$969K |
| D0120 |
Periodic oral evaluation - established patient |
40,776 |
38,113 |
$720K |
| D1999 |
|
37,736 |
34,657 |
$696K |
| D1206 |
Topical application of fluoride varnish |
31,306 |
28,883 |
$643K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,404 |
5,885 |
$515K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,895 |
4,828 |
$511K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,290 |
4,523 |
$440K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,398 |
17,127 |
$394K |
| D0330 |
Panoramic radiographic image |
9,215 |
8,574 |
$367K |
| D0272 |
Bitewings - two radiographic images |
17,599 |
16,334 |
$280K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,300 |
18,376 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,736 |
10,011 |
$250K |
| D1110 |
Prophylaxis - adult |
6,850 |
6,410 |
$232K |
| D1354 |
|
4,750 |
2,200 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
3,553 |
3,266 |
$93K |
| D0274 |
Bitewings - four radiographic images |
4,144 |
3,882 |
$88K |
| D1351 |
Sealant - per tooth |
3,342 |
1,273 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
5,761 |
5,223 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,999 |
1,364 |
$18K |
| D7240 |
Removal of impacted tooth - completely bony |
75 |
19 |
$13K |
| D0240 |
|
723 |
619 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
134 |
110 |
$10K |
| D2330 |
|
140 |
106 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
67 |
$7K |
| D3120 |
|
720 |
578 |
$6K |
| D0270 |
|
377 |
325 |
$0.00 |