| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28,735 |
9,910 |
$2.71M |
| D1120 |
Prophylaxis - child |
93,867 |
90,184 |
$2.55M |
| D1351 |
Sealant - per tooth |
111,369 |
20,715 |
$2.17M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39,437 |
17,255 |
$1.96M |
| D0120 |
Periodic oral evaluation - established patient |
72,463 |
70,063 |
$1.70M |
| D1206 |
Topical application of fluoride varnish |
96,030 |
92,227 |
$1.64M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24,663 |
12,808 |
$1.03M |
| D7140 |
Extraction, erupted tooth or exposed root |
17,108 |
9,010 |
$798K |
| D9420 |
|
2,521 |
2,354 |
$737K |
| D2933 |
|
4,487 |
1,376 |
$552K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22,330 |
21,608 |
$496K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30,698 |
29,007 |
$459K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,651 |
4,962 |
$449K |
| D0603 |
|
47,484 |
45,272 |
$378K |
| D0272 |
Bitewings - two radiographic images |
40,091 |
38,402 |
$273K |
| D0140 |
Limited oral evaluation - problem focused |
12,872 |
12,353 |
$256K |
| D0330 |
Panoramic radiographic image |
9,557 |
9,211 |
$237K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,357 |
2,391 |
$182K |
| D0274 |
Bitewings - four radiographic images |
11,245 |
10,757 |
$148K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,373 |
6,130 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
22,206 |
21,225 |
$88K |
| D9920 |
|
6,062 |
2,303 |
$79K |
| D1110 |
Prophylaxis - adult |
3,722 |
3,574 |
$76K |
| D2330 |
|
1,604 |
1,071 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,469 |
14,996 |
$54K |
| D0601 |
|
5,342 |
5,287 |
$42K |
| D0602 |
|
4,327 |
4,246 |
$33K |
| D2331 |
|
359 |
205 |
$13K |
| D7111 |
|
175 |
119 |
$8K |
| D2332 |
|
159 |
107 |
$6K |
| D2335 |
|
118 |
87 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
641 |
622 |
$5K |
| D1517 |
|
21 |
13 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,713 |
2,552 |
$2K |
| D2920 |
|
194 |
164 |
$2K |
| D0170 |
|
76 |
76 |
$2K |
| D9430 |
|
91 |
91 |
$1K |