| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,859 |
1,316 |
$1.56M |
| D2929 |
|
1,608 |
424 |
$459K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,142 |
511 |
$137K |
| D1351 |
Sealant - per tooth |
2,059 |
682 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,934 |
1,895 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
649 |
310 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
963 |
941 |
$30K |
| D1120 |
Prophylaxis - child |
1,687 |
1,647 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
413 |
407 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,154 |
1,130 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
309 |
291 |
$8K |
| D2331 |
|
59 |
28 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
303 |
287 |
$7K |
| D2330 |
|
80 |
42 |
$7K |
| D0240 |
|
757 |
389 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
144 |
142 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
253 |
$2K |
| D7962 |
|
26 |
24 |
$2K |
| D7961 |
|
13 |
13 |
$970.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
55 |
$253.59 |