| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25,230 |
5,464 |
$2.81M |
| D7140 |
Extraction, erupted tooth or exposed root |
21,485 |
6,582 |
$1.37M |
| D1120 |
Prophylaxis - child |
35,722 |
31,327 |
$787K |
| D1208 |
Topical application of fluoride, excluding varnish |
34,162 |
29,963 |
$577K |
| D2933 |
|
3,128 |
921 |
$536K |
| D0120 |
Periodic oral evaluation - established patient |
24,656 |
21,661 |
$472K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,831 |
1,326 |
$378K |
| D0330 |
Panoramic radiographic image |
5,656 |
4,927 |
$332K |
| D0240 |
|
28,432 |
10,967 |
$286K |
| D0140 |
Limited oral evaluation - problem focused |
10,525 |
9,386 |
$269K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,837 |
6,856 |
$245K |
| D0272 |
Bitewings - two radiographic images |
22,244 |
19,487 |
$234K |
| D1510 |
|
1,209 |
658 |
$169K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,458 |
2,892 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
14,891 |
12,697 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,439 |
7,954 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
915 |
459 |
$46K |
| D2140 |
|
691 |
385 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
446 |
250 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
353 |
285 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
89 |
$9K |
| D1351 |
Sealant - per tooth |
43 |
13 |
$739.20 |
| D0270 |
|
79 |
66 |
$377.00 |
| D1999 |
|
335 |
329 |
$0.00 |