| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,017 |
3,011 |
$1.20M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,000 |
3,003 |
$993K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
11,166 |
4,824 |
$748K |
| D1120 |
Prophylaxis - child |
18,765 |
18,699 |
$689K |
| D0120 |
Periodic oral evaluation - established patient |
10,496 |
10,460 |
$619K |
| D2140 |
|
9,181 |
4,700 |
$501K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,694 |
6,680 |
$445K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82,888 |
19,560 |
$444K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,408 |
3,303 |
$367K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,284 |
19,203 |
$299K |
| D1310 |
|
6,042 |
6,019 |
$272K |
| D1351 |
Sealant - per tooth |
9,505 |
3,563 |
$244K |
| D9993 |
|
2,446 |
2,444 |
$154K |
| D0220 |
Intraoral - periapical first radiographic image |
12,341 |
12,162 |
$148K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,297 |
2,297 |
$145K |
| D2160 |
|
1,589 |
1,028 |
$127K |
| D0350 |
|
9,753 |
5,728 |
$122K |
| D0272 |
Bitewings - two radiographic images |
7,904 |
7,877 |
$95K |
| D2330 |
|
953 |
615 |
$73K |
| D0603 |
|
5,006 |
4,988 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
315 |
315 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
409 |
409 |
$14K |
| D0340 |
|
256 |
256 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
36 |
36 |
$11K |
| D1510 |
|
74 |
66 |
$10K |
| D0601 |
|
679 |
679 |
$10K |
| D1110 |
Prophylaxis - adult |
113 |
113 |
$10K |
| D0330 |
Panoramic radiographic image |
292 |
292 |
$9K |
| D2331 |
|
81 |
51 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
29 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
15 |
$2K |
| D0270 |
|
144 |
144 |
$720.00 |
| D0602 |
|
32 |
32 |
$465.00 |