| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,454 |
2,676 |
$2.57M |
| D2929 |
|
6,667 |
949 |
$1.69M |
| D1351 |
Sealant - per tooth |
35,511 |
8,608 |
$773K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,863 |
1,537 |
$571K |
| D0120 |
Periodic oral evaluation - established patient |
19,965 |
19,747 |
$529K |
| D1120 |
Prophylaxis - child |
21,561 |
21,112 |
$500K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,353 |
23,849 |
$465K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,792 |
2,150 |
$322K |
| D1354 |
|
78,348 |
15,662 |
$252K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,228 |
5,899 |
$235K |
| D9920 |
|
6,883 |
6,606 |
$212K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,723 |
1,536 |
$200K |
| D9999 |
Unspecified adjunctive procedure, by report |
6,711 |
6,493 |
$198K |
| D0140 |
Limited oral evaluation - problem focused |
6,871 |
5,932 |
$150K |
| D0220 |
Intraoral - periapical first radiographic image |
17,599 |
16,541 |
$141K |
| D0330 |
Panoramic radiographic image |
3,447 |
3,412 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,901 |
942 |
$134K |
| D1110 |
Prophylaxis - adult |
3,485 |
3,426 |
$128K |
| D0272 |
Bitewings - two radiographic images |
10,771 |
10,520 |
$107K |
| D2934 |
|
750 |
154 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,413 |
15,142 |
$63K |
| D0274 |
Bitewings - four radiographic images |
3,891 |
3,808 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,405 |
2,117 |
$51K |
| D0240 |
|
4,626 |
2,318 |
$39K |
| D1999 |
|
2,442 |
2,291 |
$32K |
| D2330 |
|
254 |
110 |
$17K |
| D2331 |
|
186 |
87 |
$16K |
| D1510 |
|
56 |
40 |
$4K |
| D7111 |
|
92 |
76 |
$3K |
| D2920 |
|
65 |
62 |
$2K |