| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,019 |
3,044 |
$806K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,472 |
3,274 |
$468K |
| D3240 |
|
2,064 |
1,206 |
$420K |
| D9248 |
|
4,111 |
3,852 |
$349K |
| D9310 |
|
4,275 |
4,229 |
$297K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,898 |
2,237 |
$293K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,405 |
1,998 |
$214K |
| D1120 |
Prophylaxis - child |
3,887 |
3,877 |
$124K |
| D9920 |
|
1,273 |
1,180 |
$85K |
| D1510 |
|
830 |
610 |
$80K |
| D0272 |
Bitewings - two radiographic images |
4,384 |
4,334 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
4,011 |
3,737 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,542 |
3,532 |
$64K |
| D1517 |
|
259 |
249 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,688 |
2,682 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,687 |
5,610 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,586 |
5,193 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,414 |
1,368 |
$46K |
| D2929 |
|
190 |
105 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,800 |
1,792 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,157 |
1,157 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
1,875 |
1,066 |
$30K |
| D0330 |
Panoramic radiographic image |
881 |
877 |
$29K |
| D1351 |
Sealant - per tooth |
1,159 |
497 |
$23K |
| D2330 |
|
293 |
204 |
$22K |
| D1110 |
Prophylaxis - adult |
468 |
468 |
$22K |
| D9630 |
|
1,458 |
1,444 |
$20K |
| D1516 |
|
80 |
75 |
$17K |
| D1354 |
|
199 |
73 |
$6K |
| D2332 |
|
34 |
24 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$0.00 |