| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,440 |
1,701 |
$1.14M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,174 |
2,887 |
$411K |
| D0120 |
Periodic oral evaluation - established patient |
14,846 |
14,232 |
$369K |
| D1120 |
Prophylaxis - child |
12,577 |
12,073 |
$278K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,638 |
911 |
$268K |
| D1206 |
Topical application of fluoride varnish |
12,331 |
11,812 |
$235K |
| D2929 |
|
794 |
145 |
$182K |
| D1351 |
Sealant - per tooth |
8,199 |
2,262 |
$166K |
| D0272 |
Bitewings - two radiographic images |
15,108 |
14,429 |
$145K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,526 |
4,269 |
$123K |
| D1110 |
Prophylaxis - adult |
2,640 |
2,458 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
1,871 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,643 |
2,507 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,217 |
1,946 |
$51K |
| D0330 |
Panoramic radiographic image |
1,301 |
1,256 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
5,145 |
4,831 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
708 |
344 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,353 |
2,259 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
477 |
280 |
$27K |
| D1999 |
|
2,224 |
1,933 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
286 |
153 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,896 |
2,711 |
$7K |
| D2332 |
|
31 |
12 |
$3K |