| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,656 |
3,156 |
$1.29M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,647 |
4,055 |
$1.16M |
| D7140 |
Extraction, erupted tooth or exposed root |
4,850 |
2,221 |
$315K |
| D9420 |
|
2,448 |
2,408 |
$297K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,009 |
1,495 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
7,940 |
7,843 |
$211K |
| D0140 |
Limited oral evaluation - problem focused |
5,512 |
5,412 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,490 |
1,337 |
$203K |
| D1120 |
Prophylaxis - child |
6,995 |
6,907 |
$194K |
| D1351 |
Sealant - per tooth |
6,579 |
2,319 |
$184K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,892 |
3,750 |
$173K |
| D1206 |
Topical application of fluoride varnish |
9,212 |
9,095 |
$151K |
| D0272 |
Bitewings - two radiographic images |
5,123 |
5,052 |
$95K |
| D2390 |
|
517 |
186 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,120 |
3,732 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
5,536 |
5,411 |
$84K |
| D1510 |
|
428 |
238 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
393 |
244 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
834 |
815 |
$37K |
| D2330 |
|
486 |
255 |
$33K |
| D2332 |
|
17 |
13 |
$2K |