| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18,557 |
5,602 |
$2.22M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18,533 |
5,586 |
$1.84M |
| D1120 |
Prophylaxis - child |
39,236 |
38,992 |
$1.64M |
| D0120 |
Periodic oral evaluation - established patient |
24,718 |
24,547 |
$1.57M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19,454 |
9,104 |
$1.31M |
| D7140 |
Extraction, erupted tooth or exposed root |
18,925 |
9,348 |
$1.08M |
| D0230 |
Intraoral - periapical each additional radiographic image |
215,808 |
39,793 |
$947K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,402 |
12,360 |
$833K |
| D2140 |
|
14,459 |
7,967 |
$789K |
| D1208 |
Topical application of fluoride, excluding varnish |
39,865 |
39,619 |
$653K |
| D1351 |
Sealant - per tooth |
21,627 |
7,821 |
$643K |
| D1310 |
|
13,492 |
13,379 |
$605K |
| D0220 |
Intraoral - periapical first radiographic image |
24,146 |
23,887 |
$285K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,446 |
3,425 |
$226K |
| D2160 |
|
2,651 |
1,898 |
$211K |
| D0272 |
Bitewings - two radiographic images |
17,557 |
17,475 |
$210K |
| D9993 |
|
3,098 |
3,095 |
$197K |
| D0350 |
|
18,345 |
9,753 |
$191K |
| D0603 |
|
11,222 |
11,117 |
$164K |
| D1510 |
|
824 |
688 |
$137K |
| D2330 |
|
1,324 |
918 |
$102K |
| D2331 |
|
309 |
221 |
$25K |
| D0601 |
|
1,571 |
1,558 |
$23K |
| D1110 |
Prophylaxis - adult |
48 |
48 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$3K |
| D0270 |
|
419 |
413 |
$2K |
| D0602 |
|
66 |
66 |
$990.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$510.00 |
| D9430 |
|
13 |
13 |
$416.00 |