| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,115 |
1,095 |
$306K |
| D0120 |
Periodic oral evaluation - established patient |
7,117 |
7,096 |
$289K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,845 |
2,344 |
$277K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,078 |
791 |
$240K |
| D1120 |
Prophylaxis - child |
7,707 |
7,685 |
$230K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,879 |
9,372 |
$146K |
| D1351 |
Sealant - per tooth |
6,583 |
1,513 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,449 |
8,415 |
$90K |
| D1110 |
Prophylaxis - adult |
934 |
928 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,191 |
1,188 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
6,071 |
5,982 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,758 |
1,517 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,456 |
3,440 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
292 |
152 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
342 |
341 |
$17K |
| D9430 |
|
477 |
477 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
214 |
99 |
$12K |
| D2394 |
|
117 |
41 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
74 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
84 |
38 |
$7K |
| D2140 |
|
98 |
56 |
$5K |
| D0350 |
|
451 |
187 |
$4K |
| D4341 |
|
43 |
12 |
$3K |
| D4910 |
|
26 |
26 |
$2K |
| D1999 |
|
80 |
75 |
$138.00 |