| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30,266 |
6,198 |
$3.48M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,760 |
4,024 |
$1.05M |
| D9420 |
|
10,486 |
7,619 |
$873K |
| D9993 |
|
9,756 |
9,693 |
$560K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,580 |
7,578 |
$468K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,866 |
3,087 |
$441K |
| D1310 |
|
10,480 |
10,417 |
$433K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,135 |
1,819 |
$339K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,752 |
1,821 |
$310K |
| D2330 |
|
3,476 |
1,747 |
$260K |
| D3230 |
|
2,225 |
944 |
$219K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,258 |
8,042 |
$202K |
| D1120 |
Prophylaxis - child |
5,883 |
5,821 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
3,113 |
3,065 |
$130K |
| D0603 |
|
9,810 |
9,755 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,212 |
1,193 |
$118K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,918 |
1,916 |
$106K |
| D0350 |
|
5,718 |
4,520 |
$100K |
| D2140 |
|
1,856 |
994 |
$100K |
| D1206 |
Topical application of fluoride varnish |
4,792 |
4,735 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,271 |
5,231 |
$59K |
| D1510 |
|
428 |
313 |
$52K |
| D1351 |
Sealant - per tooth |
1,828 |
716 |
$40K |
| D9920 |
|
330 |
330 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,903 |
2,901 |
$34K |
| D2331 |
|
400 |
264 |
$32K |
| D2332 |
|
280 |
175 |
$24K |
| D2160 |
|
255 |
165 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
94 |
71 |
$8K |
| D0601 |
|
382 |
375 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
134 |
132 |
$890.00 |
| D9430 |
|
13 |
13 |
$416.00 |
| D9995 |
|
17 |
17 |
$81.84 |
| D0140 |
Limited oral evaluation - problem focused |
80 |
80 |
$0.00 |