| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,676 |
1,337 |
$787K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,107 |
2,159 |
$737K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,385 |
984 |
$447K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,026 |
1,245 |
$395K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,384 |
759 |
$250K |
| D9248 |
|
2,211 |
1,768 |
$249K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,524 |
757 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,931 |
1,788 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
2,058 |
1,889 |
$117K |
| D2335 |
|
415 |
186 |
$97K |
| D1120 |
Prophylaxis - child |
2,181 |
2,173 |
$93K |
| D1510 |
|
298 |
199 |
$85K |
| D2330 |
|
694 |
349 |
$83K |
| D0272 |
Bitewings - two radiographic images |
2,545 |
2,368 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
2,965 |
2,710 |
$77K |
| D2332 |
|
236 |
129 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,257 |
2,247 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,966 |
2,313 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,312 |
1,311 |
$40K |
| D1351 |
Sealant - per tooth |
874 |
375 |
$35K |
| D2331 |
|
80 |
51 |
$15K |
| D0603 |
|
1,179 |
1,162 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
368 |
332 |
$10K |
| D2394 |
|
31 |
25 |
$8K |
| D0330 |
Panoramic radiographic image |
47 |
47 |
$2K |
| D1999 |
|
303 |
280 |
$2K |
| D0602 |
|
140 |
140 |
$1K |
| D0601 |
|
12 |
12 |
$132.00 |