| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,875 |
5,098 |
$3.47M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,399 |
4,081 |
$1.14M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,390 |
3,448 |
$1.06M |
| D7140 |
Extraction, erupted tooth or exposed root |
9,287 |
4,030 |
$790K |
| D1120 |
Prophylaxis - child |
15,324 |
15,302 |
$615K |
| D2390 |
|
2,123 |
825 |
$423K |
| D1206 |
Topical application of fluoride varnish |
15,120 |
15,101 |
$409K |
| D0120 |
Periodic oral evaluation - established patient |
11,096 |
11,093 |
$358K |
| D1354 |
|
10,933 |
2,681 |
$300K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,619 |
7,567 |
$293K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,869 |
1,118 |
$265K |
| D9920 |
|
5,625 |
5,146 |
$249K |
| D9310 |
|
2,712 |
2,710 |
$188K |
| D2332 |
|
1,439 |
854 |
$182K |
| D1510 |
|
924 |
773 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
9,863 |
9,710 |
$172K |
| D2330 |
|
1,782 |
995 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,363 |
679 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,985 |
1,982 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
1,651 |
1,631 |
$97K |
| D1351 |
Sealant - per tooth |
3,051 |
909 |
$92K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,571 |
1,571 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,607 |
2,607 |
$62K |
| D0330 |
Panoramic radiographic image |
631 |
631 |
$43K |
| D9248 |
|
728 |
685 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
740 |
631 |
$37K |
| D0240 |
|
1,865 |
1,052 |
$35K |
| D9420 |
|
327 |
305 |
$35K |
| D2934 |
|
109 |
55 |
$24K |
| D2920 |
|
94 |
83 |
$4K |
| D0274 |
Bitewings - four radiographic images |
55 |
55 |
$2K |
| D7960 |
|
70 |
61 |
$0.00 |
| D7962 |
|
304 |
301 |
$0.00 |
| D7961 |
|
114 |
112 |
$0.00 |