| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,136 |
4,103 |
$2.09M |
| D9243 |
|
7,195 |
4,572 |
$1.61M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,587 |
3,102 |
$540K |
| D9239 |
|
5,365 |
4,482 |
$491K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,776 |
2,298 |
$306K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,018 |
1,132 |
$182K |
| D1351 |
Sealant - per tooth |
1,887 |
969 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,211 |
3,925 |
$95K |
| D1120 |
Prophylaxis - child |
2,351 |
2,021 |
$89K |
| D1354 |
|
2,694 |
1,362 |
$71K |
| D2332 |
|
691 |
488 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
8,269 |
6,996 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,979 |
1,746 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
592 |
401 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,358 |
3,782 |
$44K |
| D0272 |
Bitewings - two radiographic images |
3,826 |
3,477 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
596 |
327 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,160 |
1,101 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
416 |
$12K |
| D0330 |
Panoramic radiographic image |
590 |
563 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
54 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
164 |
137 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$617.00 |