| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,185 |
6,083 |
$2.27M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19,311 |
6,024 |
$1.91M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20,652 |
9,104 |
$1.38M |
| D1120 |
Prophylaxis - child |
33,755 |
33,679 |
$1.34M |
| D0120 |
Periodic oral evaluation - established patient |
19,420 |
19,367 |
$1.17M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,981 |
7,688 |
$906K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,533 |
32,270 |
$716K |
| D1310 |
|
14,952 |
14,921 |
$682K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,491 |
10,470 |
$665K |
| D1351 |
Sealant - per tooth |
21,425 |
7,868 |
$603K |
| D2140 |
|
10,620 |
5,544 |
$577K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,908 |
33,830 |
$534K |
| D9993 |
|
7,766 |
7,765 |
$491K |
| D2160 |
|
4,834 |
2,656 |
$383K |
| D0220 |
Intraoral - periapical first radiographic image |
19,334 |
19,146 |
$229K |
| D0603 |
|
14,334 |
14,302 |
$213K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,197 |
5,142 |
$207K |
| D0350 |
|
11,257 |
8,834 |
$186K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,580 |
2,579 |
$156K |
| D9430 |
|
3,776 |
3,626 |
$121K |
| D0274 |
Bitewings - four radiographic images |
5,252 |
5,233 |
$112K |
| D0272 |
Bitewings - two radiographic images |
9,365 |
9,345 |
$110K |
| D2330 |
|
1,059 |
622 |
$82K |
| D1510 |
|
307 |
252 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
641 |
636 |
$30K |
| D1110 |
Prophylaxis - adult |
152 |
152 |
$14K |
| D1206 |
Topical application of fluoride varnish |
532 |
532 |
$13K |
| D9920 |
|
72 |
70 |
$10K |
| D4341 |
|
100 |
25 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
64 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |
| D0602 |
|
397 |
397 |
$6K |
| D4910 |
|
40 |
40 |
$3K |
| D2161 |
|
33 |
27 |
$3K |
| D2940 |
|
17 |
12 |
$1K |