| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49,551 |
16,333 |
$5.43M |
| D1120 |
Prophylaxis - child |
83,104 |
81,992 |
$2.59M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26,785 |
11,578 |
$1.99M |
| D0120 |
Periodic oral evaluation - established patient |
74,823 |
73,856 |
$1.61M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,698 |
14,323 |
$1.56M |
| D7140 |
Extraction, erupted tooth or exposed root |
25,642 |
12,492 |
$1.45M |
| D1208 |
Topical application of fluoride, excluding varnish |
73,132 |
72,169 |
$1.39M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34,738 |
33,755 |
$987K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,965 |
9,970 |
$899K |
| D0272 |
Bitewings - two radiographic images |
47,015 |
46,357 |
$787K |
| D2390 |
|
4,657 |
1,574 |
$718K |
| D1351 |
Sealant - per tooth |
20,268 |
6,074 |
$503K |
| D2330 |
|
8,223 |
4,455 |
$486K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,324 |
16,085 |
$451K |
| D0330 |
Panoramic radiographic image |
9,519 |
9,394 |
$389K |
| D1110 |
Prophylaxis - adult |
8,153 |
8,062 |
$324K |
| D1206 |
Topical application of fluoride varnish |
16,495 |
16,286 |
$315K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,395 |
2,381 |
$297K |
| D2929 |
|
2,076 |
614 |
$261K |
| D2331 |
|
2,540 |
1,483 |
$182K |
| D0220 |
Intraoral - periapical first radiographic image |
15,590 |
15,240 |
$177K |
| D0140 |
Limited oral evaluation - problem focused |
6,863 |
6,618 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
3,067 |
3,033 |
$129K |
| D9310 |
|
1,335 |
1,335 |
$99K |
| D2335 |
|
500 |
302 |
$48K |
| D2332 |
|
558 |
363 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,884 |
3,663 |
$35K |
| D9248 |
|
388 |
372 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
282 |
$29K |
| D1354 |
|
275 |
144 |
$2K |
| D9920 |
|
30 |
30 |
$2K |
| D1510 |
|
13 |
12 |
$2K |