| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,827 |
7,357 |
$3.64M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,793 |
8,787 |
$1.47M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,332 |
6,719 |
$879K |
| D2332 |
|
4,027 |
2,636 |
$640K |
| D0120 |
Periodic oral evaluation - established patient |
24,422 |
24,185 |
$564K |
| D1206 |
Topical application of fluoride varnish |
28,503 |
28,227 |
$470K |
| D1120 |
Prophylaxis - child |
19,836 |
19,652 |
$447K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,465 |
2,752 |
$373K |
| D1351 |
Sealant - per tooth |
11,960 |
4,113 |
$244K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,006 |
1,001 |
$231K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,136 |
10,844 |
$221K |
| D1110 |
Prophylaxis - adult |
6,083 |
6,034 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,085 |
4,053 |
$169K |
| D0330 |
Panoramic radiographic image |
4,266 |
4,213 |
$162K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,081 |
5,023 |
$137K |
| D0272 |
Bitewings - two radiographic images |
13,806 |
13,634 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
15,241 |
15,068 |
$121K |
| D2929 |
|
471 |
256 |
$111K |
| D2330 |
|
1,387 |
728 |
$108K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
858 |
555 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,339 |
1,041 |
$95K |
| D0274 |
Bitewings - four radiographic images |
3,649 |
3,615 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
2,002 |
1,977 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,861 |
13,381 |
$33K |
| D1999 |
|
1,454 |
1,408 |
$19K |
| D7111 |
|
346 |
219 |
$10K |
| D2331 |
|
108 |
63 |
$9K |
| D0270 |
|
1,267 |
1,247 |
$7K |
| D1510 |
|
43 |
28 |
$3K |
| D9248 |
|
13 |
13 |
$650.00 |
| D9992 |
|
41 |
41 |
$585.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
27 |
$414.69 |