| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,121 |
4,953 |
$1.80M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,599 |
7,978 |
$1.52M |
| D9248 |
|
8,472 |
7,807 |
$1.13M |
| D1120 |
Prophylaxis - child |
31,655 |
30,573 |
$957K |
| D0120 |
Periodic oral evaluation - established patient |
35,707 |
34,588 |
$755K |
| D1206 |
Topical application of fluoride varnish |
43,123 |
41,704 |
$744K |
| D1351 |
Sealant - per tooth |
22,937 |
7,533 |
$553K |
| D1110 |
Prophylaxis - adult |
12,118 |
11,775 |
$547K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,145 |
2,317 |
$479K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,181 |
2,368 |
$469K |
| D2934 |
|
2,611 |
988 |
$393K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,879 |
3,290 |
$389K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,995 |
3,793 |
$359K |
| D0330 |
Panoramic radiographic image |
6,646 |
6,539 |
$319K |
| D0272 |
Bitewings - two radiographic images |
14,647 |
14,155 |
$266K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
790 |
790 |
$253K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,296 |
7,759 |
$225K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
651 |
651 |
$204K |
| D0274 |
Bitewings - four radiographic images |
6,729 |
6,535 |
$203K |
| D0220 |
Intraoral - periapical first radiographic image |
10,385 |
9,972 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,849 |
4,629 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
3,583 |
3,456 |
$108K |
| D0603 |
|
11,306 |
11,027 |
$103K |
| D0601 |
|
10,313 |
9,911 |
$94K |
| D1510 |
|
702 |
558 |
$84K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
71 |
45 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,371 |
2,286 |
$72K |
| D7240 |
Removal of impacted tooth - completely bony |
319 |
84 |
$70K |
| D7111 |
|
1,023 |
708 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,473 |
4,254 |
$57K |
| D9222 |
|
648 |
648 |
$51K |
| D0602 |
|
5,246 |
5,116 |
$48K |
| D9610 |
|
1,488 |
1,481 |
$45K |
| D3120 |
|
749 |
595 |
$23K |
| D2394 |
|
119 |
102 |
$20K |
| D9310 |
|
404 |
328 |
$20K |
| D2330 |
|
287 |
198 |
$17K |
| D3230 |
|
67 |
28 |
$7K |
| D0350 |
|
180 |
166 |
$5K |
| D2332 |
|
38 |
27 |
$4K |
| D0340 |
|
63 |
49 |
$4K |
| D7962 |
|
12 |
12 |
$2K |
| D0270 |
|
14 |
14 |
$213.36 |