| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,553 |
2,817 |
$2.78M |
| D0120 |
Periodic oral evaluation - established patient |
50,649 |
49,470 |
$1.61M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,234 |
8,825 |
$1.54M |
| D1120 |
Prophylaxis - child |
40,624 |
38,927 |
$1.46M |
| D1208 |
Topical application of fluoride, excluding varnish |
55,888 |
54,501 |
$1.05M |
| D1110 |
Prophylaxis - adult |
13,788 |
13,422 |
$749K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,911 |
1,764 |
$709K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,457 |
3,215 |
$640K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15,359 |
14,372 |
$604K |
| D0272 |
Bitewings - two radiographic images |
16,497 |
16,014 |
$429K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,776 |
2,099 |
$334K |
| D1354 |
|
10,730 |
1,798 |
$300K |
| D0140 |
Limited oral evaluation - problem focused |
6,070 |
5,873 |
$279K |
| D0274 |
Bitewings - four radiographic images |
7,980 |
7,776 |
$266K |
| D0330 |
Panoramic radiographic image |
4,542 |
4,407 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,284 |
3,166 |
$189K |
| D1351 |
Sealant - per tooth |
3,387 |
1,068 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
7,808 |
7,545 |
$67K |
| D2332 |
|
473 |
209 |
$54K |
| D9420 |
|
1,011 |
957 |
$54K |
| D2330 |
|
432 |
148 |
$42K |
| D2335 |
|
307 |
76 |
$38K |
| D8090 |
|
26 |
25 |
$30K |
| D3120 |
|
1,071 |
783 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,929 |
1,760 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
313 |
303 |
$14K |
| D1510 |
|
48 |
28 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$2K |
| D0603 |
|
2,819 |
1,752 |
$0.00 |
| D9986 |
|
3,867 |
3,798 |
$0.00 |
| D9987 |
|
1,908 |
1,865 |
$0.00 |
| D1999 |
|
277 |
273 |
$0.00 |
| D9996 |
|
34 |
32 |
$0.00 |