| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,111 |
3,032 |
$1.84M |
| D2929 |
|
2,269 |
501 |
$557K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,386 |
2,464 |
$331K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,356 |
1,513 |
$196K |
| D1120 |
Prophylaxis - child |
8,547 |
8,463 |
$196K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,994 |
1,639 |
$187K |
| D9630 |
|
3,986 |
3,910 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,290 |
6,248 |
$169K |
| D1206 |
Topical application of fluoride varnish |
7,540 |
7,459 |
$150K |
| D1351 |
Sealant - per tooth |
7,128 |
2,313 |
$147K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,620 |
4,519 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,703 |
2,659 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
4,914 |
4,753 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
11,393 |
10,934 |
$86K |
| D9248 |
|
1,483 |
1,449 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,870 |
3,721 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,397 |
9,176 |
$66K |
| D0272 |
Bitewings - two radiographic images |
5,219 |
5,139 |
$49K |
| D0330 |
Panoramic radiographic image |
1,609 |
1,578 |
$49K |
| D9920 |
|
1,293 |
1,260 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
420 |
256 |
$31K |
| D1999 |
|
2,603 |
2,378 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
675 |
673 |
$12K |
| D7111 |
|
436 |
294 |
$12K |
| D0274 |
Bitewings - four radiographic images |
420 |
414 |
$6K |
| D1110 |
Prophylaxis - adult |
128 |
127 |
$4K |
| D1354 |
|
840 |
220 |
$3K |
| D2331 |
|
26 |
15 |
$2K |
| D2330 |
|
34 |
27 |
$2K |
| D9440 |
|
45 |
45 |
$1K |
| D3120 |
|
168 |
122 |
$0.00 |