| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,550 |
1,802 |
$1.07M |
| D0145 |
Oral evaluation for a patient under three years of age |
7,018 |
6,912 |
$975K |
| D1120 |
Prophylaxis - child |
18,731 |
18,544 |
$675K |
| D0120 |
Periodic oral evaluation - established patient |
23,347 |
23,144 |
$664K |
| D1110 |
Prophylaxis - adult |
7,784 |
7,730 |
$422K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,788 |
2,112 |
$380K |
| D1206 |
Topical application of fluoride varnish |
25,598 |
25,370 |
$370K |
| D0272 |
Bitewings - two radiographic images |
16,279 |
16,116 |
$358K |
| D0220 |
Intraoral - periapical first radiographic image |
28,839 |
28,462 |
$337K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,165 |
27,005 |
$301K |
| D9248 |
|
2,362 |
2,334 |
$280K |
| D0274 |
Bitewings - four radiographic images |
8,122 |
8,058 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,936 |
1,923 |
$223K |
| D2335 |
|
1,410 |
510 |
$208K |
| D7240 |
Removal of impacted tooth - completely bony |
447 |
143 |
$125K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,467 |
481 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,461 |
3,409 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
1,035 |
1,035 |
$70K |
| D0330 |
Panoramic radiographic image |
3,134 |
3,103 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
653 |
395 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,736 |
1,704 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
914 |
867 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
195 |
145 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,060 |
1,045 |
$15K |
| D1351 |
Sealant - per tooth |
83 |
14 |
$2K |
| D7111 |
|
199 |
149 |
$2K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
34 |
12 |
$2K |
| D2330 |
|
16 |
13 |
$1K |
| D9222 |
|
12 |
12 |
$841.56 |
| D9986 |
|
85 |
82 |
$0.00 |
| D0603 |
|
34,809 |
34,414 |
$0.00 |