| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
62,269 |
12,933 |
$7.20M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30,475 |
9,466 |
$2.94M |
| D0120 |
Periodic oral evaluation - established patient |
50,436 |
50,287 |
$2.83M |
| D1120 |
Prophylaxis - child |
68,847 |
68,618 |
$2.67M |
| D1310 |
|
25,018 |
24,931 |
$1.12M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16,544 |
6,299 |
$1.08M |
| D1208 |
Topical application of fluoride, excluding varnish |
68,898 |
68,669 |
$1.04M |
| D1351 |
Sealant - per tooth |
31,614 |
11,395 |
$935K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,611 |
14,554 |
$931K |
| D7140 |
Extraction, erupted tooth or exposed root |
16,511 |
8,318 |
$912K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22,906 |
22,668 |
$892K |
| D2140 |
|
12,620 |
6,422 |
$673K |
| D9993 |
|
12,118 |
12,107 |
$653K |
| D0272 |
Bitewings - two radiographic images |
48,282 |
48,137 |
$551K |
| D1510 |
|
3,012 |
2,285 |
$453K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92,365 |
23,987 |
$444K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,480 |
6,464 |
$401K |
| D0603 |
|
17,346 |
17,278 |
$250K |
| D0330 |
Panoramic radiographic image |
6,007 |
5,981 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,856 |
1,405 |
$137K |
| D2330 |
|
1,758 |
1,113 |
$130K |
| D0601 |
|
6,482 |
6,471 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
2,079 |
2,078 |
$91K |
| D0350 |
|
9,811 |
8,498 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,568 |
834 |
$87K |
| D0274 |
Bitewings - four radiographic images |
4,190 |
4,185 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
6,206 |
6,112 |
$71K |
| D9430 |
|
1,863 |
1,838 |
$57K |
| D2160 |
|
722 |
459 |
$56K |
| D2332 |
|
209 |
118 |
$16K |
| D0602 |
|
997 |
995 |
$15K |
| D2931 |
|
122 |
68 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D2934 |
|
64 |
24 |
$0.00 |