| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,318 |
3,710 |
$1.35M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19,273 |
7,583 |
$1.29M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,939 |
3,443 |
$1.08M |
| D1120 |
Prophylaxis - child |
21,635 |
21,534 |
$936K |
| D0120 |
Periodic oral evaluation - established patient |
11,026 |
10,942 |
$745K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,478 |
5,898 |
$713K |
| D2140 |
|
11,802 |
5,892 |
$640K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,041 |
8,013 |
$538K |
| D1310 |
|
11,203 |
11,171 |
$509K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,018 |
19,882 |
$417K |
| D1351 |
Sealant - per tooth |
13,348 |
4,914 |
$409K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,364 |
22,258 |
$392K |
| D2160 |
|
4,609 |
2,583 |
$367K |
| D9993 |
|
4,214 |
4,214 |
$262K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,977 |
4,949 |
$198K |
| D0350 |
|
8,544 |
7,733 |
$172K |
| D0603 |
|
10,836 |
10,804 |
$160K |
| D0220 |
Intraoral - periapical first radiographic image |
13,274 |
13,003 |
$159K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,113 |
2,113 |
$141K |
| D2330 |
|
1,519 |
947 |
$118K |
| D0274 |
Bitewings - four radiographic images |
5,355 |
5,309 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,031 |
2,030 |
$97K |
| D9430 |
|
2,826 |
2,705 |
$90K |
| D1110 |
Prophylaxis - adult |
735 |
735 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,555 |
3,544 |
$42K |
| D2331 |
|
454 |
328 |
$36K |
| D1510 |
|
176 |
152 |
$34K |
| D4341 |
|
341 |
89 |
$24K |
| D1320 |
|
1,524 |
1,524 |
$22K |
| D4910 |
|
242 |
242 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
24 |
$15K |
| D9920 |
|
82 |
79 |
$11K |
| D1206 |
Topical application of fluoride varnish |
500 |
500 |
$9K |
| D2332 |
|
58 |
44 |
$5K |
| D0602 |
|
207 |
207 |
$3K |
| D3221 |
|
34 |
25 |
$2K |