| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,801 |
1,471 |
$1.09M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,313 |
1,347 |
$955K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,276 |
1,450 |
$353K |
| D0140 |
Limited oral evaluation - problem focused |
4,582 |
3,985 |
$327K |
| D9310 |
|
1,758 |
1,575 |
$170K |
| D1355 |
|
11,763 |
2,105 |
$149K |
| D9920 |
|
3,055 |
2,719 |
$139K |
| D4355 |
|
630 |
565 |
$102K |
| D1206 |
Topical application of fluoride varnish |
8,854 |
8,205 |
$65K |
| D1120 |
Prophylaxis - child |
3,658 |
3,367 |
$63K |
| D1354 |
|
6,865 |
2,158 |
$62K |
| D2940 |
|
2,495 |
1,086 |
$49K |
| D0240 |
|
1,561 |
1,264 |
$42K |
| D7922 |
|
970 |
443 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,681 |
2,466 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
1,985 |
1,758 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
688 |
569 |
$32K |
| D4346 |
|
268 |
252 |
$28K |
| D1351 |
Sealant - per tooth |
1,389 |
436 |
$27K |
| D9248 |
|
189 |
173 |
$26K |
| D2394 |
|
95 |
55 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
615 |
286 |
$11K |
| D2941 |
|
276 |
105 |
$11K |
| D0603 |
|
2,539 |
2,383 |
$9K |
| D1510 |
|
31 |
25 |
$8K |
| D9110 |
|
83 |
31 |
$6K |
| D2335 |
|
22 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
2,558 |
2,369 |
$3K |
| D0170 |
|
64 |
63 |
$3K |
| D1330 |
|
1,408 |
1,305 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
143 |
$2K |
| D0191 |
|
4,284 |
4,105 |
$2K |
| D0602 |
|
2,422 |
2,202 |
$1K |
| D0601 |
|
668 |
655 |
$21.25 |
| D9222 |
|
1,170 |
1,050 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
68 |
$0.00 |
| D1310 |
|
20 |
19 |
$0.00 |