| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,340 |
7,379 |
$2.34M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21,036 |
11,883 |
$1.38M |
| D0120 |
Periodic oral evaluation - established patient |
53,231 |
50,441 |
$1.35M |
| D1120 |
Prophylaxis - child |
58,801 |
55,751 |
$1.31M |
| D1208 |
Topical application of fluoride, excluding varnish |
60,394 |
57,120 |
$1.13M |
| D1351 |
Sealant - per tooth |
30,825 |
9,692 |
$687K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,435 |
6,663 |
$605K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25,331 |
23,144 |
$520K |
| D9999 |
Unspecified adjunctive procedure, by report |
16,812 |
15,843 |
$468K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,205 |
4,358 |
$436K |
| D0272 |
Bitewings - two radiographic images |
39,887 |
37,950 |
$380K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,653 |
8,175 |
$333K |
| D0330 |
Panoramic radiographic image |
7,859 |
7,482 |
$288K |
| D0220 |
Intraoral - periapical first radiographic image |
36,270 |
34,095 |
$278K |
| D0140 |
Limited oral evaluation - problem focused |
8,332 |
7,865 |
$173K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58,350 |
29,382 |
$128K |
| D9630 |
|
1,727 |
1,667 |
$75K |
| D1110 |
Prophylaxis - adult |
2,041 |
1,843 |
$73K |
| D1999 |
|
4,760 |
4,543 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
559 |
320 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,500 |
1,399 |
$16K |
| D2332 |
|
92 |
63 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
78 |
$7K |
| D2390 |
|
42 |
13 |
$6K |
| D2330 |
|
89 |
41 |
$4K |
| D2331 |
|
44 |
27 |
$4K |
| D1354 |
|
701 |
188 |
$2K |
| D3120 |
|
368 |
246 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |