| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
3,183 |
3,110 |
$1.92M |
| T1015 |
Clinic visit/encounter, all-inclusive |
2,129 |
2,112 |
$1.32M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,182 |
1,174 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,673 |
1,667 |
$165K |
| D9420 |
|
3,266 |
3,237 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
800 |
792 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
477 |
467 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,184 |
1,180 |
$67K |
| D2934 |
|
79 |
79 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
484 |
482 |
$28K |
| D1120 |
Prophylaxis - child |
1,155 |
1,145 |
$18K |
| D2332 |
|
130 |
127 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
928 |
919 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,507 |
1,493 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,546 |
1,533 |
$10K |
| D1351 |
Sealant - per tooth |
224 |
223 |
$7K |
| D7111 |
|
556 |
546 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
132 |
132 |
$4K |
| D2330 |
|
76 |
76 |
$4K |
| D2335 |
|
16 |
16 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
137 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$511.55 |
| D1510 |
|
13 |
13 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$0.00 |
| G0330 |
Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
21 |
20 |
$0.00 |
| D7240 |
Removal of impacted tooth - completely bony |
189 |
187 |
$0.00 |
| D7230 |
|
17 |
17 |
$0.00 |