| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,796 |
2,729 |
$2.60M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14,575 |
2,416 |
$1.43M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,646 |
3,541 |
$1.23M |
| D1120 |
Prophylaxis - child |
14,839 |
14,816 |
$878K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,695 |
4,560 |
$702K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,216 |
9,204 |
$695K |
| D1351 |
Sealant - per tooth |
18,826 |
5,063 |
$542K |
| D0120 |
Periodic oral evaluation - established patient |
9,451 |
9,424 |
$401K |
| D2140 |
|
6,177 |
3,593 |
$400K |
| D4220 |
|
1,901 |
827 |
$313K |
| D2160 |
|
2,553 |
1,796 |
$254K |
| D0210 |
Intraoral - complete series of radiographic images |
3,383 |
3,377 |
$249K |
| D1203 |
|
9,039 |
9,025 |
$183K |
| D1110 |
Prophylaxis - adult |
3,070 |
3,067 |
$155K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,597 |
4,513 |
$151K |
| D0274 |
Bitewings - four radiographic images |
4,179 |
4,174 |
$147K |
| D0220 |
Intraoral - periapical first radiographic image |
9,662 |
9,578 |
$142K |
| D1510 |
|
601 |
574 |
$138K |
| D2335 |
|
678 |
397 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,532 |
8,495 |
$102K |
| D0272 |
Bitewings - two radiographic images |
4,136 |
4,125 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
1,421 |
1,416 |
$91K |
| D2332 |
|
695 |
456 |
$85K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
537 |
371 |
$79K |
| D2330 |
|
735 |
507 |
$57K |
| D2161 |
|
359 |
308 |
$43K |
| D3120 |
|
853 |
504 |
$35K |
| D2331 |
|
186 |
139 |
$18K |
| D4341 |
|
30 |
12 |
$4K |