| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18,506 |
3,027 |
$2.11M |
| D7140 |
Extraction, erupted tooth or exposed root |
5,725 |
1,627 |
$392K |
| D2390 |
|
3,011 |
797 |
$338K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,016 |
1,148 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,767 |
3,536 |
$111K |
| D1120 |
Prophylaxis - child |
2,387 |
2,209 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,653 |
2,484 |
$31K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
902 |
724 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,877 |
1,745 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,780 |
2,608 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,105 |
1,028 |
$11K |
| D1351 |
Sealant - per tooth |
569 |
184 |
$11K |
| D8030 |
|
126 |
121 |
$10K |
| D2330 |
|
170 |
88 |
$8K |
| D1206 |
Topical application of fluoride varnish |
151 |
127 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$436.28 |
| D8670 |
Periodic orthodontic treatment visit |
77 |
51 |
$180.00 |