| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,091 |
802 |
$411K |
| D1120 |
Prophylaxis - child |
9,437 |
8,150 |
$363K |
| D1206 |
Topical application of fluoride varnish |
11,104 |
9,321 |
$345K |
| T1015 |
Clinic visit/encounter, all-inclusive |
2,302 |
2,226 |
$237K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,532 |
1,080 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
9,355 |
8,298 |
$199K |
| D1351 |
Sealant - per tooth |
5,620 |
1,587 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,061 |
1,242 |
$140K |
| D1110 |
Prophylaxis - adult |
2,640 |
2,218 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,123 |
791 |
$110K |
| D9420 |
|
405 |
368 |
$86K |
| D0330 |
Panoramic radiographic image |
1,383 |
1,266 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,769 |
2,242 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,097 |
2,720 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,206 |
1,431 |
$47K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
407 |
342 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
990 |
877 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,006 |
789 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
641 |
582 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,159 |
992 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
101 |
$8K |
| D1354 |
|
224 |
69 |
$5K |
| D0240 |
|
122 |
103 |
$3K |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
72 |
71 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
83 |
$1K |
| D7111 |
|
31 |
14 |
$1K |