| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,677 |
1,935 |
$580K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,442 |
1,423 |
$253K |
| D9248 |
|
1,842 |
1,697 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
4,299 |
4,067 |
$87K |
| D1120 |
Prophylaxis - child |
3,146 |
2,969 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,397 |
759 |
$81K |
| D1206 |
Topical application of fluoride varnish |
4,268 |
4,028 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,973 |
2,876 |
$67K |
| D0272 |
Bitewings - two radiographic images |
4,700 |
4,463 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,805 |
1,690 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,170 |
2,985 |
$36K |
| D2140 |
|
384 |
253 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
368 |
232 |
$20K |
| D1110 |
Prophylaxis - adult |
379 |
347 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,235 |
533 |
$12K |
| D1351 |
Sealant - per tooth |
358 |
135 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
75 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
45 |
34 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$475.62 |
| D1999 |
|
233 |
214 |
$0.00 |