| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,422 |
1,545 |
$854K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,076 |
1,103 |
$251K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,119 |
788 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,165 |
2,964 |
$132K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
913 |
514 |
$81K |
| D9420 |
|
848 |
750 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,248 |
2,159 |
$58K |
| D2934 |
|
223 |
78 |
$56K |
| D9248 |
|
600 |
468 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,961 |
1,868 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,037 |
2,765 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
505 |
484 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
461 |
418 |
$15K |
| D1351 |
Sealant - per tooth |
391 |
112 |
$12K |
| D1120 |
Prophylaxis - child |
308 |
288 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
39 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
174 |
170 |
$4K |
| D2335 |
|
33 |
12 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
87 |
83 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
235 |
231 |
$3K |
| D1206 |
Topical application of fluoride varnish |
104 |
96 |
$2K |
| D9920 |
|
54 |
40 |
$2K |
| D2330 |
|
26 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
55 |
$1K |