| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,625 |
4,346 |
$2.39M |
| D2335 |
|
7,003 |
2,076 |
$618K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,596 |
2,982 |
$491K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,512 |
2,111 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,742 |
6,554 |
$194K |
| D0240 |
|
17,021 |
6,828 |
$184K |
| D1351 |
Sealant - per tooth |
4,922 |
1,601 |
$91K |
| D1510 |
|
780 |
482 |
$81K |
| D0272 |
Bitewings - two radiographic images |
7,018 |
6,721 |
$74K |
| D1120 |
Prophylaxis - child |
3,503 |
3,333 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
976 |
520 |
$49K |
| D1206 |
Topical application of fluoride varnish |
3,076 |
2,936 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
3,775 |
3,559 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
131 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,106 |
1,940 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
184 |
170 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
961 |
576 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
153 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
423 |
381 |
$3K |
| D9420 |
|
530 |
493 |
$0.00 |