| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,035 |
1,803 |
$1.55M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,403 |
3,146 |
$1.06M |
| D1120 |
Prophylaxis - child |
11,954 |
11,813 |
$521K |
| D1206 |
Topical application of fluoride varnish |
14,340 |
14,164 |
$380K |
| D0120 |
Periodic oral evaluation - established patient |
11,474 |
11,344 |
$369K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,203 |
1,849 |
$351K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,048 |
1,522 |
$300K |
| D0272 |
Bitewings - two radiographic images |
7,206 |
7,116 |
$255K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,798 |
5,441 |
$234K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,355 |
3,300 |
$231K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,830 |
883 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
932 |
579 |
$169K |
| D0274 |
Bitewings - four radiographic images |
3,877 |
3,829 |
$168K |
| D1110 |
Prophylaxis - adult |
2,271 |
2,246 |
$163K |
| D2934 |
|
485 |
180 |
$119K |
| D0330 |
Panoramic radiographic image |
1,484 |
1,472 |
$106K |
| D9310 |
|
940 |
923 |
$92K |
| D1351 |
Sealant - per tooth |
2,549 |
905 |
$90K |
| D1510 |
|
458 |
329 |
$89K |
| D2335 |
|
469 |
166 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,885 |
1,838 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
3,032 |
2,960 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,276 |
2,198 |
$34K |
| D8680 |
|
62 |
56 |
$30K |
| D2394 |
|
46 |
38 |
$10K |
| D9248 |
|
63 |
61 |
$2K |
| D2920 |
|
25 |
15 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$1K |
| D8670 |
Periodic orthodontic treatment visit |
315 |
310 |
$75.00 |
| D1999 |
|
37 |
35 |
$0.00 |