| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,565 |
7,102 |
$7.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,456 |
11,216 |
$5.47M |
| D1120 |
Prophylaxis - child |
42,674 |
42,658 |
$2.42M |
| D7140 |
Extraction, erupted tooth or exposed root |
11,221 |
7,695 |
$2.01M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,978 |
4,923 |
$1.77M |
| D0120 |
Periodic oral evaluation - established patient |
42,904 |
42,894 |
$1.71M |
| D1510 |
|
3,342 |
2,751 |
$1.19M |
| D2335 |
|
3,633 |
2,304 |
$1.18M |
| D1351 |
Sealant - per tooth |
12,993 |
7,930 |
$1.04M |
| D2330 |
|
4,888 |
2,694 |
$969K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,569 |
3,108 |
$804K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,556 |
33,548 |
$786K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,779 |
2,253 |
$779K |
| D0272 |
Bitewings - two radiographic images |
23,271 |
23,264 |
$684K |
| D9420 |
|
3,172 |
3,170 |
$651K |
| D1206 |
Topical application of fluoride varnish |
14,965 |
14,951 |
$609K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,858 |
11,855 |
$588K |
| D0220 |
Intraoral - periapical first radiographic image |
24,815 |
24,788 |
$517K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,222 |
18,213 |
$500K |
| D1110 |
Prophylaxis - adult |
5,977 |
5,976 |
$448K |
| D2390 |
|
502 |
333 |
$391K |
| D0274 |
Bitewings - four radiographic images |
7,137 |
7,136 |
$332K |
| D0330 |
Panoramic radiographic image |
4,319 |
4,319 |
$296K |
| D7961 |
|
587 |
585 |
$248K |
| D1354 |
|
3,443 |
1,232 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,052 |
7,639 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
10,490 |
10,443 |
$84K |
| D7962 |
|
180 |
180 |
$83K |
| D7960 |
|
106 |
105 |
$57K |
| D9310 |
|
378 |
378 |
$46K |
| D3230 |
|
78 |
55 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
411 |
411 |
$17K |
| D2394 |
|
44 |
42 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
192 |
190 |
$5K |
| D0160 |
|
25 |
24 |
$3K |
| D1999 |
|
156 |
154 |
$0.00 |