| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,787 |
1,125 |
$702K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,583 |
1,786 |
$499K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,928 |
989 |
$307K |
| D1120 |
Prophylaxis - child |
5,787 |
5,103 |
$204K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,081 |
651 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,706 |
812 |
$150K |
| D9310 |
|
2,427 |
2,154 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,026 |
4,397 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,640 |
3,329 |
$94K |
| D0272 |
Bitewings - two radiographic images |
3,484 |
3,055 |
$74K |
| D9420 |
|
1,465 |
1,281 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,127 |
952 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,754 |
1,577 |
$36K |
| D2332 |
|
349 |
139 |
$34K |
| D1110 |
Prophylaxis - adult |
666 |
572 |
$34K |
| D1351 |
Sealant - per tooth |
1,217 |
231 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,014 |
784 |
$29K |
| D0330 |
Panoramic radiographic image |
315 |
251 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
108 |
26 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
596 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
686 |
354 |
$7K |
| D2330 |
|
86 |
37 |
$7K |
| D0240 |
|
308 |
177 |
$4K |
| D1330 |
|
572 |
548 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
34 |
$1K |
| D0274 |
Bitewings - four radiographic images |
30 |
24 |
$1K |
| D1999 |
|
1,374 |
1,017 |
$0.00 |