| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,810 |
4,903 |
$2.15M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27,344 |
15,350 |
$1.81M |
| D0120 |
Periodic oral evaluation - established patient |
66,447 |
64,108 |
$1.77M |
| D1206 |
Topical application of fluoride varnish |
71,700 |
69,086 |
$1.41M |
| D1120 |
Prophylaxis - child |
56,270 |
54,307 |
$1.30M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,306 |
8,381 |
$741K |
| D9999 |
Unspecified adjunctive procedure, by report |
25,104 |
24,178 |
$732K |
| D1351 |
Sealant - per tooth |
28,181 |
9,568 |
$630K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,632 |
1,575 |
$610K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26,888 |
23,614 |
$579K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,816 |
3,713 |
$391K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,700 |
9,277 |
$379K |
| D2390 |
|
1,772 |
567 |
$356K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,088 |
1,854 |
$330K |
| D2929 |
|
1,081 |
128 |
$290K |
| D8670 |
Periodic orthodontic treatment visit |
1,267 |
1,232 |
$281K |
| D0272 |
Bitewings - two radiographic images |
25,012 |
24,057 |
$247K |
| D0330 |
Panoramic radiographic image |
6,604 |
6,352 |
$232K |
| D1110 |
Prophylaxis - adult |
5,675 |
5,461 |
$216K |
| D1999 |
|
11,801 |
10,967 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
6,545 |
6,275 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,833 |
1,397 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
12,452 |
11,887 |
$98K |
| D0160 |
|
2,008 |
1,936 |
$72K |
| D0274 |
Bitewings - four radiographic images |
4,779 |
4,580 |
$68K |
| D2330 |
|
462 |
244 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,231 |
6,840 |
$23K |
| D8660 |
|
74 |
69 |
$18K |
| D8070 |
|
29 |
28 |
$11K |
| D2332 |
|
20 |
12 |
$2K |
| D9992 |
|
20 |
20 |
$300.00 |
| D0270 |
|
38 |
38 |
$285.12 |
| D1354 |
|
56 |
12 |
$235.20 |
| D0602 |
|
1,841 |
1,820 |
$0.00 |
| D0601 |
|
2,611 |
2,558 |
$0.00 |
| D0603 |
|
4,933 |
4,847 |
$0.00 |