| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,068 |
2,419 |
$1.62M |
| D0120 |
Periodic oral evaluation - established patient |
32,935 |
32,888 |
$940K |
| D2929 |
|
3,866 |
1,123 |
$901K |
| D1120 |
Prophylaxis - child |
36,071 |
36,006 |
$876K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,976 |
6,122 |
$863K |
| D1206 |
Topical application of fluoride varnish |
36,888 |
36,684 |
$787K |
| D1351 |
Sealant - per tooth |
22,951 |
6,203 |
$546K |
| D9999 |
Unspecified adjunctive procedure, by report |
15,846 |
15,791 |
$479K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,994 |
4,040 |
$418K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,031 |
3,264 |
$347K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,341 |
12,742 |
$290K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,786 |
6,753 |
$286K |
| D9248 |
|
5,027 |
4,746 |
$276K |
| D0272 |
Bitewings - two radiographic images |
22,404 |
22,335 |
$227K |
| D0330 |
Panoramic radiographic image |
4,460 |
4,449 |
$180K |
| D0220 |
Intraoral - periapical first radiographic image |
11,801 |
11,584 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
4,447 |
4,385 |
$96K |
| D0240 |
|
7,864 |
4,062 |
$67K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
720 |
440 |
$65K |
| D1999 |
|
5,635 |
5,312 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,247 |
7,155 |
$45K |
| D1110 |
Prophylaxis - adult |
891 |
888 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,351 |
2,344 |
$31K |
| D0274 |
Bitewings - four radiographic images |
3,301 |
3,296 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
413 |
354 |
$30K |
| D7111 |
|
107 |
76 |
$3K |
| D7960 |
|
30 |
27 |
$3K |
| D9630 |
|
34 |
34 |
$2K |
| D2331 |
|
19 |
12 |
$1K |
| D0190 |
|
31 |
30 |
$306.00 |
| D1330 |
|
31 |
30 |
$220.49 |
| D0602 |
|
44 |
44 |
$0.00 |
| D0603 |
|
7,789 |
7,764 |
$0.00 |
| D3120 |
|
27 |
25 |
$0.00 |
| D0601 |
|
18 |
18 |
$0.00 |