| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,450 |
1,475 |
$1.06M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,179 |
1,290 |
$484K |
| D2934 |
|
2,493 |
836 |
$482K |
| 0001A |
|
10,617 |
9,561 |
$244K |
| 0002A |
|
8,094 |
7,256 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,767 |
667 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,712 |
740 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,755 |
1,689 |
$77K |
| 0004A |
|
3,005 |
2,693 |
$56K |
| 0071A |
|
899 |
896 |
$41K |
| 0031A |
|
2,078 |
1,822 |
$41K |
| 0011A |
|
1,184 |
1,066 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,527 |
1,450 |
$28K |
| 0072A |
|
502 |
502 |
$23K |
| D7240 |
Removal of impacted tooth - completely bony |
106 |
40 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,556 |
1,474 |
$20K |
| D1120 |
Prophylaxis - child |
2,098 |
1,680 |
$19K |
| 0012A |
|
809 |
713 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,810 |
1,579 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
423 |
418 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,752 |
1,439 |
$17K |
| 0064A |
|
776 |
689 |
$16K |
| D0330 |
Panoramic radiographic image |
254 |
244 |
$13K |
| 0124A |
|
582 |
442 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
130 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
282 |
276 |
$7K |
| D9243 |
|
104 |
58 |
$7K |
| D9239 |
|
65 |
60 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
443 |
410 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
27 |
$4K |
| 0134A |
|
182 |
139 |
$3K |
| 0013A |
|
145 |
125 |
$2K |
| 0003A |
|
161 |
158 |
$2K |
| 0034A |
|
143 |
117 |
$1K |
| D1351 |
Sealant - per tooth |
38 |
16 |
$892.85 |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
54 |
$711.72 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18 |
18 |
$564.77 |
| 0074A |
|
12 |
12 |
$0.00 |
| 91303 |
|
1,539 |
1,354 |
$0.00 |
| 91307 |
|
1,430 |
1,348 |
$0.00 |
| 91301 |
|
1,567 |
1,411 |
$0.00 |
| 91306 |
|
496 |
461 |
$0.00 |
| 90688 |
|
15 |
13 |
$0.00 |
| 90674 |
|
358 |
338 |
$0.00 |
| 91312 |
|
425 |
279 |
$0.00 |
| 91300 |
|
15,696 |
13,126 |
$0.00 |
| 91313 |
|
119 |
88 |
$0.00 |