| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,061 |
2,221 |
$847K |
| D1120 |
Prophylaxis - child |
15,972 |
15,940 |
$741K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,172 |
2,150 |
$712K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,619 |
4,040 |
$579K |
| D0120 |
Periodic oral evaluation - established patient |
7,486 |
7,470 |
$551K |
| D1310 |
|
9,331 |
9,311 |
$426K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,389 |
3,008 |
$367K |
| D2160 |
|
4,456 |
2,282 |
$355K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,184 |
5,179 |
$353K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,377 |
16,342 |
$320K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,874 |
14,978 |
$302K |
| D1351 |
Sealant - per tooth |
8,987 |
3,316 |
$297K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,009 |
4,959 |
$200K |
| D2140 |
|
3,456 |
1,897 |
$189K |
| D9993 |
|
2,570 |
2,570 |
$159K |
| D0603 |
|
9,280 |
9,260 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
9,749 |
9,674 |
$117K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,522 |
1,520 |
$102K |
| D0350 |
|
4,949 |
4,347 |
$102K |
| D9430 |
|
2,454 |
2,410 |
$78K |
| D2330 |
|
1,002 |
516 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,451 |
3,445 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,470 |
2,464 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
544 |
544 |
$26K |
| D2161 |
|
236 |
148 |
$20K |
| D1110 |
Prophylaxis - adult |
168 |
168 |
$15K |
| D4910 |
|
92 |
92 |
$7K |
| D1206 |
Topical application of fluoride varnish |
205 |
205 |
$4K |
| D3221 |
|
41 |
28 |
$3K |
| D9920 |
|
17 |
17 |
$2K |