| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,066 |
3,675 |
$1.14M |
| D1120 |
Prophylaxis - child |
32,392 |
31,123 |
$1.04M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,373 |
5,423 |
$705K |
| D0120 |
Periodic oral evaluation - established patient |
30,548 |
29,419 |
$700K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,529 |
29,361 |
$582K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,892 |
4,219 |
$498K |
| D9248 |
|
6,479 |
5,843 |
$464K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,435 |
2,408 |
$407K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,316 |
2,655 |
$334K |
| D0210 |
Intraoral - complete series of radiographic images |
5,456 |
5,213 |
$295K |
| D8670 |
Periodic orthodontic treatment visit |
3,249 |
2,783 |
$293K |
| D0272 |
Bitewings - two radiographic images |
18,883 |
18,084 |
$250K |
| D1110 |
Prophylaxis - adult |
5,270 |
5,076 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,318 |
7,026 |
$188K |
| D0220 |
Intraoral - periapical first radiographic image |
13,456 |
12,461 |
$156K |
| D1351 |
Sealant - per tooth |
6,334 |
2,111 |
$154K |
| D1206 |
Topical application of fluoride varnish |
7,025 |
6,770 |
$138K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,058 |
4,596 |
$136K |
| D0274 |
Bitewings - four radiographic images |
5,217 |
4,991 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,516 |
978 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
2,732 |
2,585 |
$59K |
| D2934 |
|
465 |
140 |
$51K |
| D1510 |
|
308 |
243 |
$44K |
| D8660 |
|
900 |
891 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,014 |
3,362 |
$36K |
| D3230 |
|
642 |
166 |
$32K |
| D1515 |
|
130 |
102 |
$27K |
| D2330 |
|
348 |
224 |
$20K |
| D2332 |
|
141 |
99 |
$10K |
| D0330 |
Panoramic radiographic image |
222 |
207 |
$8K |
| D1517 |
|
29 |
28 |
$6K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
38 |
24 |
$3K |
| D1516 |
|
17 |
13 |
$3K |
| D9222 |
|
30 |
24 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
104 |
$2K |
| D1555 |
|
34 |
29 |
$1K |
| D1558 |
|
12 |
12 |
$561.60 |
| D9610 |
|
24 |
24 |
$539.95 |
| D1354 |
|
62 |
24 |
$355.63 |
| D9420 |
|
622 |
568 |
$180.00 |
| D0171 |
|
13 |
13 |
$0.00 |
| D1999 |
|
6,354 |
5,766 |
$0.00 |