| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26,361 |
5,068 |
$3.09M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
20,399 |
5,087 |
$1.79M |
| D1120 |
Prophylaxis - child |
44,807 |
44,262 |
$1.32M |
| D0120 |
Periodic oral evaluation - established patient |
56,446 |
55,762 |
$1.16M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,463 |
5,965 |
$1.14M |
| D1208 |
Topical application of fluoride, excluding varnish |
59,710 |
58,981 |
$880K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,020 |
5,304 |
$711K |
| D1110 |
Prophylaxis - adult |
15,282 |
15,098 |
$675K |
| D0220 |
Intraoral - periapical first radiographic image |
37,755 |
37,262 |
$555K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,238 |
5,009 |
$537K |
| D0272 |
Bitewings - two radiographic images |
29,518 |
29,241 |
$521K |
| D2934 |
|
4,127 |
1,364 |
$510K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,999 |
9,622 |
$267K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,869 |
32,195 |
$249K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,468 |
6,301 |
$189K |
| D0330 |
Panoramic radiographic image |
3,461 |
3,394 |
$163K |
| D0140 |
Limited oral evaluation - problem focused |
4,492 |
4,424 |
$132K |
| D2330 |
|
1,810 |
903 |
$107K |
| D1351 |
Sealant - per tooth |
447 |
171 |
$11K |