| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,257 |
1,757 |
$1.01M |
| D0120 |
Periodic oral evaluation - established patient |
15,660 |
15,288 |
$610K |
| D1206 |
Topical application of fluoride varnish |
19,379 |
18,969 |
$601K |
| D1120 |
Prophylaxis - child |
13,568 |
13,257 |
$598K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,802 |
1,163 |
$248K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,508 |
1,180 |
$241K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,604 |
968 |
$232K |
| D1110 |
Prophylaxis - adult |
3,159 |
3,088 |
$211K |
| D0272 |
Bitewings - two radiographic images |
5,417 |
5,278 |
$188K |
| D2934 |
|
724 |
227 |
$186K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,614 |
5,279 |
$123K |
| D1351 |
Sealant - per tooth |
3,037 |
807 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,004 |
506 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,149 |
602 |
$90K |
| D9310 |
|
1,414 |
1,395 |
$88K |
| D0240 |
|
4,108 |
2,132 |
$80K |
| D2140 |
|
845 |
411 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,809 |
1,320 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,520 |
1,480 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,041 |
1,027 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,055 |
1,024 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,057 |
2,001 |
$41K |
| D9420 |
|
1,308 |
1,219 |
$40K |
| D2330 |
|
168 |
94 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
342 |
311 |
$14K |
| D0330 |
Panoramic radiographic image |
162 |
162 |
$10K |
| D2933 |
|
229 |
66 |
$7K |
| D9995 |
|
12 |
12 |
$0.00 |