| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,770 |
3,645 |
$2.09M |
| D0120 |
Periodic oral evaluation - established patient |
33,709 |
32,907 |
$1.17M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,871 |
5,950 |
$1.17M |
| D1120 |
Prophylaxis - child |
32,143 |
31,332 |
$1.11M |
| D1206 |
Topical application of fluoride varnish |
31,249 |
30,310 |
$854K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,625 |
3,776 |
$763K |
| D0272 |
Bitewings - two radiographic images |
17,369 |
16,924 |
$534K |
| D1351 |
Sealant - per tooth |
16,848 |
5,183 |
$470K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,470 |
3,701 |
$425K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,533 |
6,414 |
$299K |
| D0330 |
Panoramic radiographic image |
2,495 |
2,437 |
$216K |
| D1110 |
Prophylaxis - adult |
3,885 |
3,793 |
$207K |
| D0220 |
Intraoral - periapical first radiographic image |
9,581 |
9,243 |
$191K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,993 |
7,016 |
$163K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,275 |
7,581 |
$161K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,757 |
1,021 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
2,752 |
2,691 |
$140K |
| D1510 |
|
648 |
461 |
$127K |
| D9420 |
|
4,089 |
3,871 |
$102K |
| D0274 |
Bitewings - four radiographic images |
1,874 |
1,835 |
$88K |
| D2330 |
|
1,189 |
674 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,167 |
6,078 |
$67K |
| D2331 |
|
660 |
386 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
252 |
155 |
$29K |
| D2332 |
|
176 |
103 |
$22K |
| D2933 |
|
79 |
26 |
$20K |
| D1354 |
|
148 |
66 |
$4K |
| D9985 |
|
132 |
126 |
$0.00 |
| D9995 |
|
24 |
24 |
$0.00 |
| D1999 |
|
24 |
24 |
$0.00 |