| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,442 |
1,873 |
$685K |
| D1120 |
Prophylaxis - child |
13,150 |
13,125 |
$560K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,409 |
1,895 |
$442K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,329 |
2,447 |
$408K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,710 |
2,252 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
9,971 |
9,957 |
$342K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,689 |
10,675 |
$281K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,599 |
1,942 |
$238K |
| D0210 |
Intraoral - complete series of radiographic images |
2,211 |
2,187 |
$179K |
| D1510 |
|
867 |
714 |
$172K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,426 |
3,705 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
2,013 |
2,001 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
6,566 |
6,495 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,838 |
1,829 |
$103K |
| D0272 |
Bitewings - two radiographic images |
3,838 |
3,837 |
$98K |
| D1206 |
Topical application of fluoride varnish |
3,254 |
3,242 |
$95K |
| D1110 |
Prophylaxis - adult |
1,526 |
1,524 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,007 |
1,006 |
$40K |
| D2330 |
|
427 |
274 |
$35K |
| D1354 |
|
1,228 |
328 |
$34K |
| D1351 |
Sealant - per tooth |
911 |
323 |
$27K |
| D9310 |
|
317 |
317 |
$24K |
| D9420 |
|
107 |
105 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
169 |
169 |
$7K |
| D2331 |
|
55 |
38 |
$6K |