| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,789 |
1,622 |
$1.23M |
| D0120 |
Periodic oral evaluation - established patient |
40,019 |
39,378 |
$1.06M |
| D1120 |
Prophylaxis - child |
35,973 |
35,253 |
$852K |
| D1206 |
Topical application of fluoride varnish |
42,449 |
41,578 |
$823K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,000 |
3,225 |
$500K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,075 |
2,921 |
$345K |
| D9999 |
Unspecified adjunctive procedure, by report |
11,759 |
11,451 |
$345K |
| D2929 |
|
1,231 |
361 |
$290K |
| D0272 |
Bitewings - two radiographic images |
27,759 |
27,225 |
$278K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,502 |
2,340 |
$254K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,899 |
917 |
$250K |
| D1351 |
Sealant - per tooth |
11,833 |
2,993 |
$249K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,413 |
5,128 |
$208K |
| D1110 |
Prophylaxis - adult |
5,224 |
5,125 |
$207K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,450 |
7,076 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
9,929 |
9,669 |
$80K |
| D1999 |
|
4,831 |
4,640 |
$66K |
| D9920 |
|
2,358 |
2,326 |
$64K |
| D0274 |
Bitewings - four radiographic images |
4,352 |
4,262 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,480 |
2,433 |
$52K |
| D0240 |
|
5,259 |
2,673 |
$44K |
| D9248 |
|
880 |
831 |
$43K |
| D0330 |
Panoramic radiographic image |
872 |
867 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,867 |
4,199 |
$23K |
| D9992 |
|
15 |
13 |
$195.00 |