| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,268 |
2,288 |
$1.48M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,310 |
3,867 |
$513K |
| D0120 |
Periodic oral evaluation - established patient |
13,365 |
13,093 |
$367K |
| D2390 |
|
1,423 |
424 |
$356K |
| D9630 |
|
7,882 |
7,738 |
$347K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,690 |
2,965 |
$346K |
| D1120 |
Prophylaxis - child |
13,951 |
13,647 |
$332K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,762 |
15,419 |
$326K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,879 |
996 |
$300K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,044 |
2,279 |
$284K |
| D1351 |
Sealant - per tooth |
6,488 |
1,878 |
$152K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,028 |
5,483 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
16,466 |
15,929 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,036 |
2,955 |
$125K |
| D0272 |
Bitewings - two radiographic images |
11,883 |
11,645 |
$117K |
| D0330 |
Panoramic radiographic image |
2,874 |
2,793 |
$96K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,976 |
2,913 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,542 |
15,219 |
$91K |
| D1110 |
Prophylaxis - adult |
2,043 |
2,009 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
1,541 |
1,496 |
$34K |
| D1999 |
|
2,386 |
1,898 |
$30K |
| D3230 |
|
168 |
53 |
$11K |
| D2330 |
|
159 |
84 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
99 |
$8K |
| D0274 |
Bitewings - four radiographic images |
254 |
218 |
$3K |
| D2331 |
|
19 |
14 |
$1K |
| D9215 |
|
110 |
98 |
$0.00 |