| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,219 |
3,603 |
$2.67M |
| D2390 |
|
3,401 |
1,039 |
$707K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,603 |
3,852 |
$697K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,423 |
3,924 |
$559K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,318 |
19,567 |
$401K |
| D1120 |
Prophylaxis - child |
18,038 |
17,459 |
$393K |
| D0120 |
Periodic oral evaluation - established patient |
13,876 |
13,638 |
$378K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,651 |
1,793 |
$323K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,710 |
2,808 |
$309K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,813 |
5,416 |
$220K |
| D9999 |
Unspecified adjunctive procedure, by report |
7,193 |
6,898 |
$208K |
| D2331 |
|
1,503 |
781 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
5,536 |
5,194 |
$112K |
| D0272 |
Bitewings - two radiographic images |
8,922 |
8,594 |
$87K |
| D9248 |
|
1,561 |
1,469 |
$87K |
| D2330 |
|
1,170 |
638 |
$78K |
| D0330 |
Panoramic radiographic image |
1,793 |
1,727 |
$63K |
| D9920 |
|
2,512 |
2,375 |
$54K |
| D1351 |
Sealant - per tooth |
1,965 |
909 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,918 |
4,605 |
$37K |
| D1110 |
Prophylaxis - adult |
883 |
866 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
363 |
256 |
$26K |
| D1999 |
|
4,677 |
4,401 |
$22K |
| D1510 |
|
267 |
188 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,412 |
4,026 |
$10K |
| D0240 |
|
976 |
492 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
147 |
141 |
$3K |