| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,911 |
1,522 |
$1.04M |
| D0120 |
Periodic oral evaluation - established patient |
14,518 |
14,475 |
$390K |
| D1120 |
Prophylaxis - child |
14,099 |
14,033 |
$335K |
| D1206 |
Topical application of fluoride varnish |
15,221 |
15,152 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,303 |
1,566 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,183 |
1,508 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,141 |
1,535 |
$174K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,807 |
5,649 |
$172K |
| D1351 |
Sealant - per tooth |
3,632 |
1,170 |
$82K |
| D0272 |
Bitewings - two radiographic images |
7,382 |
7,317 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,412 |
3,244 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,600 |
1,574 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
3,090 |
2,987 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
6,720 |
6,564 |
$55K |
| D1110 |
Prophylaxis - adult |
1,274 |
1,272 |
$49K |
| D0330 |
Panoramic radiographic image |
1,117 |
1,114 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,254 |
4,297 |
$26K |
| D1999 |
|
2,052 |
1,950 |
$24K |
| D0274 |
Bitewings - four radiographic images |
808 |
807 |
$11K |
| D9920 |
|
110 |
108 |
$4K |
| D9248 |
|
69 |
68 |
$3K |
| D0270 |
|
300 |
294 |
$2K |
| D2331 |
|
19 |
13 |
$2K |
| D1354 |
|
268 |
83 |
$955.80 |
| D1330 |
|
49 |
24 |
$298.31 |
| D0190 |
|
49 |
24 |
$234.60 |