| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,113 |
2,477 |
$1.65M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,878 |
8,663 |
$1.06M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,720 |
8,386 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
39,441 |
39,264 |
$1.04M |
| D1120 |
Prophylaxis - child |
38,229 |
38,003 |
$891K |
| D1206 |
Topical application of fluoride varnish |
37,694 |
37,451 |
$754K |
| D1351 |
Sealant - per tooth |
18,390 |
5,079 |
$400K |
| D2390 |
|
2,053 |
736 |
$391K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,996 |
1,452 |
$329K |
| D9999 |
Unspecified adjunctive procedure, by report |
10,800 |
10,737 |
$323K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,040 |
14,556 |
$313K |
| D1110 |
Prophylaxis - adult |
6,963 |
6,913 |
$270K |
| D0220 |
Intraoral - periapical first radiographic image |
33,522 |
32,789 |
$269K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,236 |
2,071 |
$239K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102,683 |
30,408 |
$237K |
| D0330 |
Panoramic radiographic image |
6,625 |
6,547 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,533 |
5,449 |
$215K |
| D9248 |
|
2,308 |
2,273 |
$126K |
| D9630 |
|
2,566 |
2,519 |
$112K |
| D0272 |
Bitewings - two radiographic images |
11,728 |
11,621 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,361 |
6,327 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
4,183 |
4,105 |
$85K |
| D1999 |
|
6,029 |
5,652 |
$78K |
| D0274 |
Bitewings - four radiographic images |
6,035 |
5,970 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
664 |
466 |
$52K |
| D2330 |
|
742 |
456 |
$43K |
| D7111 |
|
892 |
625 |
$26K |
| D2331 |
|
238 |
157 |
$18K |
| D9920 |
|
159 |
158 |
$4K |
| D0270 |
|
29 |
29 |
$134.64 |
| D9986 |
|
16 |
16 |
$0.00 |