| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,432 |
3,337 |
$1.57M |
| D2934 |
|
3,516 |
1,059 |
$770K |
| D1120 |
Prophylaxis - child |
17,708 |
17,527 |
$643K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,447 |
2,800 |
$616K |
| D0120 |
Periodic oral evaluation - established patient |
17,652 |
17,450 |
$511K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,667 |
3,131 |
$394K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,075 |
2,924 |
$370K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,989 |
3,474 |
$362K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,261 |
13,117 |
$279K |
| D0210 |
Intraoral - complete series of radiographic images |
4,084 |
4,025 |
$235K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,144 |
5,814 |
$222K |
| D1110 |
Prophylaxis - adult |
4,046 |
3,991 |
$212K |
| D1351 |
Sealant - per tooth |
5,968 |
1,668 |
$192K |
| D1206 |
Topical application of fluoride varnish |
7,414 |
7,329 |
$184K |
| D0272 |
Bitewings - two radiographic images |
7,439 |
7,313 |
$166K |
| D9420 |
|
1,604 |
1,562 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,183 |
10,213 |
$146K |
| D9248 |
|
2,925 |
1,987 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
12,888 |
12,394 |
$128K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,229 |
2,210 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,714 |
1,695 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
3,676 |
3,626 |
$53K |
| D2330 |
|
462 |
316 |
$38K |
| D0330 |
Panoramic radiographic image |
140 |
136 |
$8K |
| D2331 |
|
32 |
25 |
$4K |