| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,688 |
2,534 |
$1.70M |
| D7140 |
Extraction, erupted tooth or exposed root |
5,678 |
2,270 |
$517K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,605 |
1,416 |
$391K |
| D9310 |
|
2,095 |
1,985 |
$211K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,326 |
1,966 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,529 |
791 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,860 |
3,162 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,437 |
761 |
$109K |
| D2933 |
|
656 |
160 |
$103K |
| D1351 |
Sealant - per tooth |
6,429 |
1,992 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,566 |
1,427 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
3,858 |
3,441 |
$57K |
| D2330 |
|
538 |
278 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,196 |
1,112 |
$43K |
| D0330 |
Panoramic radiographic image |
677 |
659 |
$36K |
| D9248 |
|
384 |
302 |
$35K |
| D0272 |
Bitewings - two radiographic images |
4,301 |
4,129 |
$30K |
| D1354 |
|
7,576 |
1,876 |
$25K |
| D0170 |
|
368 |
356 |
$23K |
| D1120 |
Prophylaxis - child |
5,821 |
5,597 |
$14K |
| D1510 |
|
95 |
53 |
$12K |
| D0240 |
|
883 |
503 |
$11K |
| D1206 |
Topical application of fluoride varnish |
6,738 |
6,480 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
5,456 |
5,263 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
507 |
503 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,506 |
1,462 |
$1K |
| D0602 |
|
4,966 |
4,776 |
$697.35 |
| D1355 |
|
361 |
66 |
$470.00 |
| D0603 |
|
1,676 |
1,595 |
$457.35 |
| D0601 |
|
1,145 |
1,126 |
$373.00 |
| D1330 |
|
7,570 |
7,299 |
$215.81 |
| D1999 |
|
478 |
427 |
$49.00 |
| D1310 |
|
560 |
516 |
$0.00 |
| D0191 |
|
2,371 |
2,313 |
$0.00 |