| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,711 |
1,228 |
$700K |
| D0240 |
|
8,596 |
6,400 |
$486K |
| D9420 |
|
1,699 |
1,442 |
$265K |
| D1510 |
|
378 |
213 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,894 |
2,468 |
$161K |
| D9920 |
|
2,277 |
1,811 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
5,253 |
4,451 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
591 |
488 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,208 |
705 |
$49K |
| D2390 |
|
391 |
126 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,238 |
1,244 |
$36K |
| D1120 |
Prophylaxis - child |
7,372 |
6,233 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,549 |
6,370 |
$25K |
| D1206 |
Topical application of fluoride varnish |
7,311 |
6,179 |
$17K |
| D1351 |
Sealant - per tooth |
3,114 |
715 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
634 |
510 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
912 |
390 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
7,882 |
6,666 |
$7K |
| D1330 |
|
8,022 |
6,810 |
$4K |
| D0603 |
|
1,125 |
1,112 |
$3K |
| D2332 |
|
176 |
78 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
170 |
141 |
$2K |
| D1999 |
|
53 |
53 |
$2K |
| D3120 |
|
27 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
56 |
41 |
$0.00 |