| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,413 |
1,060 |
$413K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,916 |
2,346 |
$314K |
| D1351 |
Sealant - per tooth |
13,916 |
2,868 |
$284K |
| D1120 |
Prophylaxis - child |
11,283 |
11,086 |
$257K |
| D0120 |
Periodic oral evaluation - established patient |
10,168 |
10,043 |
$256K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,943 |
1,942 |
$201K |
| D1206 |
Topical application of fluoride varnish |
9,654 |
9,429 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,653 |
3,539 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
12,170 |
11,688 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,367 |
4,024 |
$89K |
| D0272 |
Bitewings - two radiographic images |
9,357 |
9,196 |
$89K |
| D0330 |
Panoramic radiographic image |
2,529 |
2,482 |
$85K |
| D1110 |
Prophylaxis - adult |
2,278 |
2,248 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,140 |
641 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,655 |
11,965 |
$51K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
722 |
327 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,622 |
2,595 |
$44K |
| D9248 |
|
828 |
781 |
$42K |
| D2390 |
|
202 |
71 |
$39K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,205 |
1,178 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,562 |
1,466 |
$30K |
| D1999 |
|
1,650 |
1,534 |
$21K |
| D9630 |
|
498 |
483 |
$21K |
| D9920 |
|
674 |
654 |
$17K |
| D2331 |
|
239 |
139 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
128 |
$13K |
| D2330 |
|
185 |
122 |
$11K |
| D0274 |
Bitewings - four radiographic images |
663 |
650 |
$8K |
| D2332 |
|
56 |
32 |
$5K |
| D0190 |
|
232 |
137 |
$1K |
| D4346 |
|
25 |
25 |
$720.00 |
| D0240 |
|
64 |
32 |
$552.42 |
| D7111 |
|
14 |
12 |
$469.42 |
| D1330 |
|
55 |
55 |
$0.00 |