| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,306 |
1,283 |
$635K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,643 |
865 |
$243K |
| D9999 |
Unspecified adjunctive procedure, by report |
7,493 |
7,225 |
$210K |
| D1206 |
Topical application of fluoride varnish |
7,584 |
7,382 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
5,762 |
5,670 |
$176K |
| D1120 |
Prophylaxis - child |
7,219 |
7,030 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,301 |
958 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,419 |
2,289 |
$95K |
| D1351 |
Sealant - per tooth |
4,104 |
1,322 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,110 |
447 |
$63K |
| D9920 |
|
1,621 |
1,534 |
$50K |
| D0272 |
Bitewings - two radiographic images |
4,434 |
4,312 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,979 |
1,868 |
$39K |
| D2332 |
|
407 |
154 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,664 |
4,409 |
$36K |
| D0240 |
|
3,974 |
2,126 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
384 |
213 |
$22K |
| D1999 |
|
1,492 |
1,392 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,975 |
3,308 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
551 |
491 |
$10K |
| D2331 |
|
93 |
59 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
370 |
346 |
$7K |
| D2941 |
|
59 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$3K |
| D2330 |
|
20 |
14 |
$1K |
| D9440 |
|
20 |
18 |
$575.64 |
| D0190 |
|
1,216 |
1,131 |
$0.00 |