| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,479 |
2,090 |
$664K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,357 |
2,146 |
$298K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,115 |
1,406 |
$267K |
| D1120 |
Prophylaxis - child |
6,011 |
6,011 |
$246K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,779 |
1,440 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,358 |
6,358 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
5,107 |
5,105 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,253 |
3,575 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
2,087 |
2,061 |
$127K |
| D2140 |
|
1,548 |
1,184 |
$110K |
| D1351 |
Sealant - per tooth |
3,421 |
1,498 |
$107K |
| D0272 |
Bitewings - two radiographic images |
3,376 |
3,376 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
4,482 |
4,455 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
637 |
$38K |
| D9920 |
|
339 |
293 |
$17K |
| D1110 |
Prophylaxis - adult |
186 |
186 |
$10K |
| D1510 |
|
41 |
37 |
$8K |
| D2331 |
|
65 |
55 |
$7K |
| D0191 |
|
306 |
306 |
$6K |
| D2160 |
|
44 |
41 |
$5K |
| D2332 |
|
31 |
26 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,616 |
3,628 |
$0.00 |