| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,002 |
2,484 |
$2.00M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,107 |
1,939 |
$490K |
| D2934 |
|
2,586 |
803 |
$370K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,653 |
8,034 |
$356K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,991 |
5,848 |
$196K |
| D1351 |
Sealant - per tooth |
7,327 |
1,596 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,765 |
1,214 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
9,092 |
8,757 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
2,227 |
2,192 |
$97K |
| D0350 |
|
5,344 |
5,197 |
$64K |
| D9420 |
|
1,657 |
1,634 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
713 |
326 |
$52K |
| D1120 |
Prophylaxis - child |
1,408 |
1,368 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,179 |
1,139 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
262 |
145 |
$25K |
| D1330 |
|
2,563 |
2,502 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
133 |
131 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,230 |
1,195 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
594 |
563 |
$15K |
| D0272 |
Bitewings - two radiographic images |
498 |
490 |
$11K |
| D2390 |
|
83 |
28 |
$6K |
| D0274 |
Bitewings - four radiographic images |
170 |
165 |
$6K |
| D1110 |
Prophylaxis - adult |
96 |
95 |
$5K |
| D1206 |
Topical application of fluoride varnish |
266 |
263 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
135 |
$2K |
| D0170 |
|
146 |
141 |
$2K |
| D1354 |
|
163 |
45 |
$2K |
| D2330 |
|
21 |
12 |
$1K |
| D0603 |
|
8,463 |
8,210 |
$0.00 |
| D0602 |
|
721 |
711 |
$0.00 |
| D0601 |
|
57 |
55 |
$0.00 |
| D0171 |
|
30 |
27 |
$0.00 |