| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,844 |
1,535 |
$705K |
| D0120 |
Periodic oral evaluation - established patient |
13,546 |
13,250 |
$355K |
| D1120 |
Prophylaxis - child |
13,281 |
12,975 |
$303K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,341 |
2,152 |
$299K |
| D1206 |
Topical application of fluoride varnish |
13,622 |
13,311 |
$262K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,393 |
4,290 |
$121K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,136 |
628 |
$90K |
| D2929 |
|
453 |
121 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,432 |
884 |
$80K |
| D1351 |
Sealant - per tooth |
3,455 |
1,112 |
$76K |
| D0272 |
Bitewings - two radiographic images |
7,633 |
7,429 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,732 |
1,639 |
$67K |
| D9248 |
|
1,126 |
1,047 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,502 |
2,349 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
789 |
473 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
2,093 |
1,996 |
$43K |
| D0330 |
Panoramic radiographic image |
1,028 |
1,005 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,467 |
3,259 |
$27K |
| D1999 |
|
2,022 |
1,946 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,534 |
1,298 |
$10K |
| D0240 |
|
648 |
619 |
$6K |
| D2390 |
|
23 |
12 |
$3K |
| D2331 |
|
13 |
12 |
$996.73 |
| D2330 |
|
15 |
12 |
$932.95 |
| D1354 |
|
148 |
48 |
$456.00 |
| D0601 |
|
39 |
39 |
$0.00 |
| D0603 |
|
223 |
220 |
$0.00 |