| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,044 |
917 |
$586K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,632 |
571 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,509 |
456 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,618 |
1,498 |
$73K |
| D9248 |
|
368 |
307 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
632 |
597 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
358 |
191 |
$34K |
| D9420 |
|
328 |
302 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,675 |
1,532 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,799 |
1,630 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,880 |
1,073 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
366 |
335 |
$5K |
| D1120 |
Prophylaxis - child |
138 |
125 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
106 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
78 |
78 |
$2K |
| D1351 |
Sealant - per tooth |
36 |
12 |
$1K |
| D9920 |
|
15 |
12 |
$911.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$474.48 |