| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,330 |
3,063 |
$2.68M |
| D2929 |
|
5,217 |
1,187 |
$1.28M |
| D0120 |
Periodic oral evaluation - established patient |
45,308 |
45,181 |
$1.26M |
| D1120 |
Prophylaxis - child |
46,192 |
46,045 |
$1.11M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,673 |
6,252 |
$844K |
| D1206 |
Topical application of fluoride varnish |
38,123 |
38,023 |
$831K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,006 |
4,376 |
$524K |
| D9999 |
Unspecified adjunctive procedure, by report |
16,045 |
15,987 |
$487K |
| D1351 |
Sealant - per tooth |
18,810 |
6,174 |
$447K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,359 |
13,024 |
$291K |
| D0272 |
Bitewings - two radiographic images |
27,278 |
27,176 |
$276K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,399 |
6,359 |
$272K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,539 |
2,758 |
$272K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,707 |
8,645 |
$128K |
| D0330 |
Panoramic radiographic image |
2,919 |
2,913 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
4,669 |
4,560 |
$98K |
| D1110 |
Prophylaxis - adult |
2,586 |
2,575 |
$98K |
| D9248 |
|
1,655 |
1,605 |
$92K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
932 |
527 |
$88K |
| D2330 |
|
1,131 |
507 |
$78K |
| D1999 |
|
5,986 |
5,811 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
8,235 |
8,131 |
$66K |
| D0274 |
Bitewings - four radiographic images |
3,465 |
3,445 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
345 |
277 |
$28K |
| D0240 |
|
3,037 |
1,582 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,831 |
4,819 |
$18K |
| D2331 |
|
33 |
26 |
$4K |
| D7962 |
|
40 |
30 |
$2K |
| D7961 |
|
41 |
32 |
$2K |
| D1330 |
|
159 |
159 |
$0.00 |