| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,047 |
2,880 |
$1.18M |
| D0120 |
Periodic oral evaluation - established patient |
36,884 |
36,701 |
$979K |
| D1120 |
Prophylaxis - child |
37,331 |
37,033 |
$889K |
| D1208 |
Topical application of fluoride, excluding varnish |
38,816 |
38,490 |
$751K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,290 |
4,588 |
$663K |
| D1351 |
Sealant - per tooth |
22,964 |
4,899 |
$535K |
| D9920 |
|
11,605 |
11,101 |
$350K |
| D9999 |
Unspecified adjunctive procedure, by report |
11,044 |
10,854 |
$330K |
| D0272 |
Bitewings - two radiographic images |
30,501 |
30,259 |
$310K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,871 |
2,248 |
$214K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,068 |
1,738 |
$191K |
| D0330 |
Panoramic radiographic image |
3,999 |
3,965 |
$166K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,379 |
6,968 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,834 |
3,700 |
$157K |
| D1110 |
Prophylaxis - adult |
2,736 |
2,717 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
3,117 |
3,011 |
$64K |
| D1999 |
|
4,987 |
4,630 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
4,944 |
4,769 |
$40K |
| D0240 |
|
5,446 |
2,222 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
288 |
213 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,060 |
1,056 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
69 |
$7K |
| D2332 |
|
52 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,035 |
534 |
$2K |
| D9110 |
|
41 |
41 |
$2K |
| D1510 |
|
22 |
13 |
$1K |
| D9992 |
|
46 |
46 |
$675.00 |
| D1206 |
Topical application of fluoride varnish |
61 |
59 |
$621.06 |
| D1330 |
|
148 |
135 |
$0.00 |