| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,262 |
2,375 |
$451K |
| D2390 |
|
1,821 |
549 |
$373K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,691 |
1,193 |
$325K |
| D1120 |
Prophylaxis - child |
7,092 |
7,082 |
$304K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,392 |
1,275 |
$298K |
| D0120 |
Periodic oral evaluation - established patient |
7,210 |
7,195 |
$252K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,825 |
7,740 |
$250K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,485 |
7,472 |
$209K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,643 |
1,174 |
$207K |
| D0220 |
Intraoral - periapical first radiographic image |
8,809 |
8,577 |
$168K |
| D0140 |
Limited oral evaluation - problem focused |
2,166 |
2,060 |
$133K |
| D2332 |
|
830 |
472 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
596 |
398 |
$91K |
| D7970 |
|
254 |
254 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
891 |
848 |
$67K |
| D9248 |
|
1,131 |
932 |
$60K |
| D1510 |
|
326 |
305 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
566 |
301 |
$53K |
| D1110 |
Prophylaxis - adult |
853 |
850 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
577 |
577 |
$36K |
| D1351 |
Sealant - per tooth |
1,089 |
306 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,221 |
1,220 |
$32K |
| D2330 |
|
102 |
39 |
$9K |
| D2920 |
|
75 |
45 |
$4K |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$986.40 |