| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,456 |
1,616 |
$727K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,443 |
1,616 |
$638K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,215 |
2,207 |
$349K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,120 |
1,858 |
$235K |
| D2140 |
|
3,753 |
1,966 |
$204K |
| D1120 |
Prophylaxis - child |
6,902 |
6,770 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,728 |
6,657 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,890 |
2,883 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
3,678 |
3,673 |
$129K |
| D1351 |
Sealant - per tooth |
4,639 |
1,657 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,066 |
6,929 |
$86K |
| D2160 |
|
812 |
495 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,167 |
4,038 |
$47K |
| D2330 |
|
547 |
398 |
$42K |
| D0350 |
|
3,952 |
2,316 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
838 |
837 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,892 |
2,876 |
$32K |
| D1510 |
|
269 |
201 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
630 |
629 |
$28K |
| D1110 |
Prophylaxis - adult |
106 |
106 |
$6K |