| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,548 |
2,757 |
$878K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,264 |
2,351 |
$609K |
| D1351 |
Sealant - per tooth |
20,774 |
4,167 |
$406K |
| D1120 |
Prophylaxis - child |
13,924 |
13,561 |
$352K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,673 |
2,792 |
$307K |
| D2932 |
|
2,993 |
1,086 |
$282K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,078 |
2,184 |
$250K |
| D1206 |
Topical application of fluoride varnish |
13,759 |
13,401 |
$200K |
| D9420 |
|
713 |
648 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,370 |
5,218 |
$129K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,978 |
1,187 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
7,057 |
6,898 |
$109K |
| D0272 |
Bitewings - two radiographic images |
7,311 |
7,127 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,776 |
5,436 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
8,598 |
8,360 |
$68K |
| D1510 |
|
464 |
304 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,272 |
7,676 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,193 |
1,145 |
$19K |
| D2330 |
|
310 |
218 |
$14K |
| D9310 |
|
380 |
374 |
$8K |
| D9920 |
|
424 |
399 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$4K |
| D7111 |
|
60 |
44 |
$4K |
| D0274 |
Bitewings - four radiographic images |
208 |
204 |
$4K |
| D0330 |
Panoramic radiographic image |
70 |
69 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
173 |
168 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
98 |
93 |
$883.00 |
| D9430 |
|
707 |
685 |
$675.00 |
| D3120 |
|
18 |
13 |
$0.00 |