| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
115,926 |
21,788 |
$13.62M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31,190 |
12,234 |
$2.73M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27,116 |
9,759 |
$2.68M |
| D7140 |
Extraction, erupted tooth or exposed root |
40,269 |
16,278 |
$2.59M |
| D1120 |
Prophylaxis - child |
78,544 |
76,611 |
$2.35M |
| D3230 |
|
24,061 |
7,285 |
$2.33M |
| D9248 |
|
11,714 |
11,635 |
$1.53M |
| D0120 |
Periodic oral evaluation - established patient |
72,037 |
70,142 |
$1.51M |
| D1206 |
Topical application of fluoride varnish |
84,482 |
82,373 |
$1.37M |
| D1351 |
Sealant - per tooth |
40,766 |
12,499 |
$958K |
| D0272 |
Bitewings - two radiographic images |
44,316 |
43,308 |
$793K |
| D2932 |
|
5,302 |
1,522 |
$767K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,005 |
7,047 |
$757K |
| D0330 |
Panoramic radiographic image |
14,885 |
14,547 |
$710K |
| D2331 |
|
7,796 |
4,289 |
$681K |
| D9310 |
|
13,886 |
13,634 |
$661K |
| D2330 |
|
9,006 |
4,916 |
$528K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18,103 |
17,851 |
$482K |
| D0220 |
Intraoral - periapical first radiographic image |
27,021 |
26,342 |
$402K |
| D1510 |
|
2,933 |
2,146 |
$344K |
| D0140 |
Limited oral evaluation - problem focused |
9,979 |
9,712 |
$296K |
| D1110 |
Prophylaxis - adult |
5,448 |
5,276 |
$244K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,559 |
6,438 |
$195K |
| D7111 |
|
3,050 |
1,415 |
$178K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,534 |
18,023 |
$138K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,917 |
3,807 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
797 |
483 |
$113K |
| D0274 |
Bitewings - four radiographic images |
2,932 |
2,861 |
$87K |
| D1517 |
|
450 |
441 |
$81K |
| D1515 |
|
477 |
388 |
$81K |
| D3120 |
|
1,238 |
749 |
$37K |
| D2929 |
|
248 |
78 |
$30K |
| D1516 |
|
84 |
84 |
$15K |
| D2332 |
|
93 |
61 |
$9K |
| D2931 |
|
19 |
12 |
$3K |
| D7960 |
|
17 |
14 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
17 |
$1K |
| D1550 |
|
12 |
12 |
$405.84 |