| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,609 |
3,109 |
$1.71M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,395 |
2,965 |
$631K |
| D1120 |
Prophylaxis - child |
11,480 |
11,469 |
$479K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,807 |
1,716 |
$374K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,596 |
7,023 |
$344K |
| D0120 |
Periodic oral evaluation - established patient |
8,674 |
8,667 |
$305K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,977 |
1,851 |
$300K |
| D1206 |
Topical application of fluoride varnish |
9,460 |
9,444 |
$267K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,780 |
1,206 |
$236K |
| D1351 |
Sealant - per tooth |
7,424 |
2,205 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,688 |
3,676 |
$188K |
| D2934 |
|
735 |
285 |
$177K |
| D1510 |
|
876 |
673 |
$167K |
| D0220 |
Intraoral - periapical first radiographic image |
8,438 |
8,356 |
$161K |
| D0140 |
Limited oral evaluation - problem focused |
1,972 |
1,957 |
$119K |
| D2390 |
|
461 |
223 |
$91K |
| D0330 |
Panoramic radiographic image |
1,185 |
1,181 |
$72K |
| D2330 |
|
751 |
533 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,792 |
2,788 |
$67K |
| D9310 |
|
785 |
785 |
$61K |
| D0272 |
Bitewings - two radiographic images |
1,918 |
1,917 |
$44K |
| D1110 |
Prophylaxis - adult |
681 |
680 |
$38K |
| D9248 |
|
356 |
349 |
$29K |
| D9420 |
|
146 |
145 |
$19K |
| D0274 |
Bitewings - four radiographic images |
476 |
475 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
260 |
260 |
$11K |