| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,368 |
2,737 |
$761K |
| D9248 |
|
2,672 |
2,576 |
$486K |
| D1120 |
Prophylaxis - child |
14,117 |
14,031 |
$417K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,271 |
2,957 |
$399K |
| D1206 |
Topical application of fluoride varnish |
15,757 |
15,580 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
12,576 |
12,407 |
$245K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,314 |
2,074 |
$164K |
| D0272 |
Bitewings - two radiographic images |
7,480 |
7,396 |
$121K |
| D1351 |
Sealant - per tooth |
5,071 |
1,770 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,666 |
2,580 |
$116K |
| D2390 |
|
747 |
272 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,867 |
4,822 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,653 |
1,049 |
$97K |
| D8670 |
Periodic orthodontic treatment visit |
223 |
221 |
$70K |
| D0330 |
Panoramic radiographic image |
1,806 |
1,786 |
$66K |
| D1510 |
|
425 |
298 |
$51K |
| D9920 |
|
357 |
350 |
$44K |
| D1110 |
Prophylaxis - adult |
1,269 |
1,244 |
$43K |
| D2330 |
|
775 |
502 |
$38K |
| D0240 |
|
1,705 |
1,666 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
505 |
$22K |
| D1354 |
|
511 |
399 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,955 |
1,935 |
$16K |
| D2331 |
|
204 |
148 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
424 |
393 |
$9K |
| D0191 |
|
37 |
37 |
$460.00 |
| D1330 |
|
11,208 |
11,093 |
$0.00 |
| D9992 |
|
5,952 |
5,893 |
$0.00 |
| D1310 |
|
11,215 |
11,097 |
$0.00 |
| D9994 |
|
47 |
47 |
$0.00 |
| D9991 |
|
4,895 |
4,878 |
$0.00 |
| D9993 |
|
777 |
733 |
$0.00 |