| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,859 |
1,369 |
$813K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,179 |
842 |
$250K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,403 |
5,117 |
$223K |
| D2934 |
|
1,514 |
444 |
$214K |
| D0145 |
Oral evaluation for a patient under three years of age |
718 |
712 |
$95K |
| D1120 |
Prophylaxis - child |
2,462 |
2,429 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,662 |
2,599 |
$80K |
| D1351 |
Sealant - per tooth |
2,871 |
821 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,321 |
697 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
6,220 |
5,969 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,307 |
2,268 |
$63K |
| D0350 |
|
6,684 |
6,503 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,221 |
3,172 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,139 |
1,054 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
149 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
447 |
440 |
$26K |
| D0274 |
Bitewings - four radiographic images |
483 |
466 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
647 |
625 |
$11K |
| D1110 |
Prophylaxis - adult |
221 |
217 |
$11K |
| D9420 |
|
315 |
305 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
72 |
$8K |
| D0330 |
Panoramic radiographic image |
505 |
492 |
$4K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$301.60 |
| D0603 |
|
6,270 |
6,164 |
$0.00 |