| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
32,965 |
6,541 |
$4.38M |
| D7140 |
Extraction, erupted tooth or exposed root |
11,253 |
4,687 |
$866K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,631 |
3,310 |
$647K |
| D1120 |
Prophylaxis - child |
17,577 |
16,745 |
$433K |
| D0120 |
Periodic oral evaluation - established patient |
12,598 |
11,937 |
$272K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,556 |
13,828 |
$272K |
| D0140 |
Limited oral evaluation - problem focused |
8,188 |
7,724 |
$251K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,053 |
2,080 |
$207K |
| D0272 |
Bitewings - two radiographic images |
14,632 |
13,841 |
$189K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,164 |
5,631 |
$171K |
| D1351 |
Sealant - per tooth |
5,610 |
1,923 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,138 |
3,975 |
$136K |
| D1510 |
|
925 |
656 |
$130K |
| D2335 |
|
1,189 |
496 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,745 |
1,170 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
8,655 |
8,061 |
$59K |
| D2330 |
|
832 |
491 |
$54K |
| D9248 |
|
448 |
417 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,912 |
1,844 |
$35K |
| D2331 |
|
398 |
252 |
$28K |
| D9222 |
|
174 |
172 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,945 |
1,351 |
$13K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
180 |
176 |
$6K |
| D0274 |
Bitewings - four radiographic images |
164 |
154 |
$4K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$3K |
| D1110 |
Prophylaxis - adult |
43 |
43 |
$2K |