| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,760 |
1,015 |
$225K |
| D1120 |
Prophylaxis - child |
4,467 |
4,432 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,463 |
4,428 |
$116K |
| D1351 |
Sealant - per tooth |
2,186 |
670 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,671 |
3,639 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
991 |
728 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,831 |
1,810 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
621 |
482 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
655 |
510 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,324 |
1,306 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,159 |
2,142 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,446 |
3,401 |
$22K |
| D2140 |
|
460 |
366 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,973 |
2,666 |
$15K |
| D1110 |
Prophylaxis - adult |
190 |
188 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
65 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
266 |
262 |
$5K |
| D4341 |
|
18 |
13 |
$3K |