| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26,165 |
8,137 |
$2.83M |
| D1120 |
Prophylaxis - child |
79,531 |
76,861 |
$2.59M |
| D0120 |
Periodic oral evaluation - established patient |
82,933 |
80,166 |
$1.95M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,559 |
11,290 |
$1.47M |
| D1208 |
Topical application of fluoride, excluding varnish |
71,369 |
68,849 |
$1.44M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,992 |
12,531 |
$1.23M |
| D1351 |
Sealant - per tooth |
28,002 |
9,403 |
$812K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29,070 |
27,216 |
$795K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,027 |
7,263 |
$782K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,774 |
2,885 |
$777K |
| D1110 |
Prophylaxis - adult |
17,338 |
16,686 |
$718K |
| D0272 |
Bitewings - two radiographic images |
39,037 |
37,719 |
$645K |
| D0330 |
Panoramic radiographic image |
16,105 |
15,575 |
$640K |
| D9248 |
|
7,772 |
7,074 |
$580K |
| D1206 |
Topical application of fluoride varnish |
22,989 |
22,325 |
$466K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,075 |
15,412 |
$444K |
| D2933 |
|
1,534 |
381 |
$242K |
| D0220 |
Intraoral - periapical first radiographic image |
16,373 |
15,660 |
$188K |
| D0140 |
Limited oral evaluation - problem focused |
6,822 |
6,482 |
$145K |
| D0274 |
Bitewings - four radiographic images |
4,449 |
4,144 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
872 |
555 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,615 |
4,426 |
$58K |
| D1353 |
|
2,165 |
889 |
$47K |
| D2330 |
|
501 |
328 |
$29K |
| D2332 |
|
300 |
180 |
$23K |
| D1354 |
|
2,202 |
794 |
$14K |
| D2390 |
|
79 |
37 |
$8K |
| D1510 |
|
30 |
26 |
$4K |
| D2931 |
|
17 |
13 |
$2K |
| D2331 |
|
28 |
13 |
$2K |
| D1352 |
|
16 |
13 |
$482.88 |
| D9420 |
|
1,276 |
1,260 |
$310.00 |
| D1999 |
|
783 |
747 |
$0.00 |