| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,397 |
5,734 |
$2.68M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25,806 |
15,331 |
$2.57M |
| D0120 |
Periodic oral evaluation - established patient |
59,376 |
55,404 |
$1.47M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,651 |
11,125 |
$1.47M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29,256 |
26,413 |
$1.24M |
| D1120 |
Prophylaxis - child |
41,400 |
38,764 |
$1.08M |
| D1206 |
Topical application of fluoride varnish |
64,445 |
60,123 |
$992K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,932 |
7,163 |
$787K |
| D1110 |
Prophylaxis - adult |
17,957 |
16,687 |
$651K |
| D1510 |
|
2,872 |
1,854 |
$512K |
| D2934 |
|
2,834 |
862 |
$501K |
| D1351 |
Sealant - per tooth |
18,086 |
7,590 |
$424K |
| D0330 |
Panoramic radiographic image |
8,167 |
7,591 |
$404K |
| D2335 |
|
3,371 |
1,312 |
$398K |
| D0272 |
Bitewings - two radiographic images |
23,120 |
21,656 |
$393K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,024 |
2,329 |
$369K |
| D3230 |
|
2,642 |
827 |
$363K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,468 |
2,270 |
$346K |
| D0274 |
Bitewings - four radiographic images |
9,306 |
8,592 |
$278K |
| D9420 |
|
2,169 |
2,035 |
$245K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,003 |
5,557 |
$243K |
| D7971 |
|
1,420 |
984 |
$208K |
| D0140 |
Limited oral evaluation - problem focused |
5,451 |
5,073 |
$194K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,084 |
2,723 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
7,362 |
6,797 |
$105K |
| D2332 |
|
377 |
197 |
$31K |
| D2330 |
|
207 |
142 |
$13K |
| D0170 |
|
368 |
355 |
$10K |
| D1354 |
|
227 |
127 |
$2K |
| D9110 |
|
36 |
26 |
$1K |
| D0240 |
|
65 |
64 |
$1K |