| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9630 |
|
40,572 |
37,882 |
$1.79M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,123 |
2,958 |
$1.69M |
| D1351 |
Sealant - per tooth |
44,007 |
8,771 |
$1.02M |
| D1120 |
Prophylaxis - child |
26,993 |
26,591 |
$655K |
| D0120 |
Periodic oral evaluation - established patient |
23,367 |
23,148 |
$644K |
| D9920 |
|
18,225 |
17,496 |
$550K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,752 |
19,568 |
$342K |
| D0330 |
Panoramic radiographic image |
7,668 |
7,456 |
$305K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,945 |
2,092 |
$281K |
| D9999 |
Unspecified adjunctive procedure, by report |
8,743 |
8,561 |
$270K |
| D1206 |
Topical application of fluoride varnish |
8,724 |
8,494 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,810 |
5,604 |
$236K |
| D1354 |
|
61,914 |
6,994 |
$199K |
| D0140 |
Limited oral evaluation - problem focused |
9,060 |
8,473 |
$191K |
| D0272 |
Bitewings - two radiographic images |
15,456 |
15,211 |
$156K |
| D2390 |
|
317 |
92 |
$89K |
| D1110 |
Prophylaxis - adult |
2,082 |
2,064 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,198 |
3,084 |
$71K |
| D1999 |
|
2,530 |
2,435 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
248 |
112 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
377 |
111 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
832 |
787 |
$7K |
| D0240 |
|
214 |
201 |
$2K |