| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,436 |
4,524 |
$2.27M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,592 |
3,101 |
$831K |
| D2390 |
|
3,000 |
1,340 |
$654K |
| D1120 |
Prophylaxis - child |
16,180 |
15,670 |
$572K |
| D9248 |
|
4,681 |
4,226 |
$558K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,366 |
3,487 |
$516K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,391 |
3,165 |
$478K |
| D0120 |
Periodic oral evaluation - established patient |
15,669 |
15,018 |
$428K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,857 |
2,861 |
$402K |
| D0272 |
Bitewings - two radiographic images |
16,389 |
15,555 |
$264K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,869 |
12,294 |
$254K |
| D0350 |
|
10,315 |
5,642 |
$234K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,752 |
4,581 |
$228K |
| D1351 |
Sealant - per tooth |
7,305 |
2,088 |
$210K |
| D0220 |
Intraoral - periapical first radiographic image |
12,819 |
12,320 |
$195K |
| D1110 |
Prophylaxis - adult |
3,503 |
3,315 |
$167K |
| D0330 |
Panoramic radiographic image |
2,794 |
2,733 |
$163K |
| D1206 |
Topical application of fluoride varnish |
6,436 |
6,294 |
$162K |
| D9920 |
|
2,713 |
2,328 |
$150K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,407 |
2,380 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,133 |
2,881 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,452 |
1,373 |
$89K |
| D2330 |
|
769 |
497 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,954 |
2,741 |
$41K |
| D7111 |
|
335 |
217 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,138 |
1,038 |
$14K |