| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,922 |
1,282 |
$573K |
| D2390 |
|
1,237 |
378 |
$247K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,985 |
893 |
$173K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,411 |
1,001 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,739 |
772 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,559 |
1,114 |
$147K |
| D9248 |
|
964 |
949 |
$127K |
| D1120 |
Prophylaxis - child |
3,280 |
3,280 |
$96K |
| D9310 |
|
1,375 |
1,375 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,985 |
2,985 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,542 |
3,542 |
$52K |
| D2330 |
|
817 |
485 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,362 |
2,362 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
491 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
973 |
968 |
$14K |
| D1110 |
Prophylaxis - adult |
293 |
293 |
$13K |
| D1351 |
Sealant - per tooth |
248 |
88 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
190 |
$5K |
| D3221 |
|
40 |
12 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$2K |