| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
105,282 |
14,497 |
$15.05M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35,133 |
10,139 |
$2.84M |
| D2934 |
|
17,304 |
4,703 |
$2.49M |
| D7140 |
Extraction, erupted tooth or exposed root |
20,510 |
7,854 |
$1.24M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,075 |
4,335 |
$1.08M |
| D7240 |
Removal of impacted tooth - completely bony |
3,238 |
1,241 |
$870K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,658 |
3,591 |
$705K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,777 |
20,471 |
$670K |
| D0210 |
Intraoral - complete series of radiographic images |
10,388 |
10,195 |
$656K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
823 |
551 |
$471K |
| D1351 |
Sealant - per tooth |
17,677 |
4,860 |
$442K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,748 |
12,207 |
$264K |
| D0140 |
Limited oral evaluation - problem focused |
13,916 |
13,655 |
$232K |
| D0330 |
Panoramic radiographic image |
4,002 |
3,912 |
$198K |
| D0350 |
|
17,310 |
16,868 |
$184K |
| D0272 |
Bitewings - two radiographic images |
10,970 |
10,832 |
$177K |
| D1330 |
|
13,418 |
13,218 |
$145K |
| D7230 |
|
796 |
392 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
14,098 |
13,653 |
$118K |
| D2330 |
|
804 |
451 |
$58K |
| D7111 |
|
3,892 |
1,756 |
$42K |
| D2394 |
|
379 |
259 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
302 |
160 |
$28K |
| D9310 |
|
1,921 |
1,902 |
$27K |
| D0160 |
|
1,407 |
1,407 |
$21K |
| D0240 |
|
2,595 |
2,581 |
$18K |
| D2931 |
|
72 |
54 |
$10K |
| D3310 |
|
26 |
12 |
$8K |
| D0460 |
|
2,903 |
1,643 |
$7K |
| D2950 |
|
21 |
14 |
$602.00 |
| D0274 |
Bitewings - four radiographic images |
29 |
27 |
$408.40 |
| D1352 |
|
17 |
12 |
$262.08 |
| D0603 |
|
39,127 |
35,844 |
$68.38 |
| D1999 |
|
430 |
422 |
$0.00 |