| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,504 |
1,028 |
$153K |
| D1351 |
Sealant - per tooth |
6,388 |
2,540 |
$138K |
| D1120 |
Prophylaxis - child |
6,752 |
6,648 |
$133K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,025 |
1,277 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
7,442 |
7,330 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,105 |
7,982 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,448 |
853 |
$83K |
| D0330 |
Panoramic radiographic image |
1,641 |
1,599 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,220 |
774 |
$61K |
| D1110 |
Prophylaxis - adult |
1,800 |
1,769 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,174 |
2,122 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
989 |
694 |
$52K |
| D0272 |
Bitewings - two radiographic images |
5,126 |
5,034 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
809 |
497 |
$42K |
| D2140 |
|
1,023 |
582 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,022 |
947 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
344 |
322 |
$2K |
| D2330 |
|
53 |
13 |
$1K |