| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,864 |
7,772 |
$2.85M |
| D0120 |
Periodic oral evaluation - established patient |
85,622 |
84,651 |
$2.27M |
| D1120 |
Prophylaxis - child |
96,137 |
94,766 |
$2.18M |
| D1206 |
Topical application of fluoride varnish |
94,897 |
93,524 |
$1.88M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22,597 |
10,274 |
$1.58M |
| D9999 |
Unspecified adjunctive procedure, by report |
36,657 |
35,980 |
$1.10M |
| D1351 |
Sealant - per tooth |
44,606 |
11,714 |
$991K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,425 |
8,048 |
$791K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,721 |
4,145 |
$693K |
| D0272 |
Bitewings - two radiographic images |
71,656 |
70,636 |
$686K |
| D0220 |
Intraoral - periapical first radiographic image |
84,679 |
82,953 |
$659K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,656 |
15,076 |
$618K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24,046 |
22,635 |
$506K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,576 |
3,822 |
$317K |
| D0330 |
Panoramic radiographic image |
6,727 |
6,649 |
$265K |
| D0230 |
Intraoral - periapical each additional radiographic image |
80,592 |
74,839 |
$221K |
| D0140 |
Limited oral evaluation - problem focused |
10,314 |
9,973 |
$214K |
| D2929 |
|
540 |
168 |
$160K |
| D2390 |
|
743 |
228 |
$149K |
| D1999 |
|
11,638 |
10,611 |
$142K |
| D9630 |
|
2,988 |
2,970 |
$130K |
| D2332 |
|
667 |
362 |
$64K |
| D9248 |
|
1,113 |
1,054 |
$58K |
| D9920 |
|
1,438 |
1,368 |
$37K |
| D7240 |
Removal of impacted tooth - completely bony |
185 |
66 |
$29K |
| D1110 |
Prophylaxis - adult |
825 |
818 |
$28K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
113 |
110 |
$17K |
| D1354 |
|
3,699 |
1,370 |
$14K |
| D2330 |
|
182 |
99 |
$11K |
| D2331 |
|
123 |
69 |
$10K |
| D9222 |
|
112 |
110 |
$9K |
| D9612 |
|
112 |
110 |
$4K |
| D1510 |
|
46 |
38 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$779.64 |
| D0270 |
|
13 |
12 |
$95.04 |