| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,435 |
2,214 |
$1.01M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,796 |
1,711 |
$307K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,095 |
1,457 |
$171K |
| D9248 |
|
1,639 |
1,634 |
$146K |
| D2934 |
|
744 |
434 |
$94K |
| D1351 |
Sealant - per tooth |
981 |
620 |
$62K |
| D1120 |
Prophylaxis - child |
1,662 |
1,656 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
620 |
469 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
799 |
627 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,615 |
1,604 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
591 |
584 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,627 |
1,621 |
$37K |
| D1510 |
|
397 |
349 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,505 |
1,778 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
584 |
581 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,996 |
1,974 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
748 |
741 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
435 |
434 |
$8K |
| D0330 |
Panoramic radiographic image |
323 |
317 |
$6K |
| D1354 |
|
239 |
170 |
$6K |
| D0272 |
Bitewings - two radiographic images |
534 |
532 |
$5K |
| D2330 |
|
44 |
41 |
$3K |
| D0274 |
Bitewings - four radiographic images |
66 |
66 |
$998.71 |