| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,586 |
1,933 |
$789K |
| D1120 |
Prophylaxis - child |
14,917 |
14,851 |
$723K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,703 |
1,816 |
$665K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
9,462 |
3,940 |
$635K |
| D0120 |
Periodic oral evaluation - established patient |
6,589 |
6,558 |
$508K |
| D1310 |
|
9,198 |
9,155 |
$420K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,144 |
5,118 |
$353K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,438 |
15,364 |
$325K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,619 |
2,715 |
$322K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,608 |
14,462 |
$283K |
| D1351 |
Sealant - per tooth |
7,863 |
2,823 |
$273K |
| D2160 |
|
2,770 |
1,540 |
$221K |
| D2140 |
|
3,685 |
2,021 |
$201K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,998 |
1,988 |
$138K |
| D0603 |
|
9,184 |
9,143 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,318 |
3,290 |
$132K |
| D9430 |
|
3,873 |
3,708 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
10,220 |
10,110 |
$123K |
| D9993 |
|
1,582 |
1,579 |
$96K |
| D0350 |
|
3,708 |
3,551 |
$78K |
| D2330 |
|
743 |
454 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,618 |
2,602 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
974 |
974 |
$47K |
| D1110 |
Prophylaxis - adult |
463 |
463 |
$41K |
| D4910 |
|
401 |
399 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,838 |
1,821 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
26 |
$15K |
| D4341 |
|
186 |
50 |
$13K |
| D2161 |
|
110 |
65 |
$9K |
| D1206 |
Topical application of fluoride varnish |
466 |
466 |
$8K |
| D3221 |
|
61 |
56 |
$4K |
| D1510 |
|
14 |
12 |
$3K |
| D1320 |
|
176 |
176 |
$3K |
| D0270 |
|
13 |
12 |
$65.00 |