| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,368 |
2,144 |
$1.67M |
| D2929 |
|
1,330 |
345 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
7,553 |
7,463 |
$189K |
| D1206 |
Topical application of fluoride varnish |
9,880 |
9,763 |
$189K |
| D1120 |
Prophylaxis - child |
9,537 |
9,415 |
$183K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,124 |
5,047 |
$137K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,163 |
574 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,683 |
2,629 |
$92K |
| D1351 |
Sealant - per tooth |
4,116 |
1,365 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
937 |
510 |
$61K |
| D0272 |
Bitewings - two radiographic images |
5,800 |
5,711 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,486 |
2,353 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
851 |
455 |
$48K |
| D0240 |
|
2,784 |
1,436 |
$23K |
| D1999 |
|
1,258 |
1,176 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,462 |
1,424 |
$11K |
| D2330 |
|
162 |
67 |
$10K |
| D2331 |
|
107 |
51 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
398 |
380 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
70 |
$7K |
| D1110 |
Prophylaxis - adult |
137 |
136 |
$5K |
| D0330 |
Panoramic radiographic image |
110 |
110 |
$4K |
| D0274 |
Bitewings - four radiographic images |
224 |
221 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
183 |
97 |
$412.38 |
| D1354 |
|
35 |
13 |
$105.00 |