| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,476 |
935 |
$468K |
| D9248 |
|
1,941 |
1,705 |
$181K |
| D1120 |
Prophylaxis - child |
3,280 |
2,978 |
$109K |
| D2140 |
|
1,648 |
721 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,206 |
3,808 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,180 |
603 |
$79K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
930 |
354 |
$77K |
| D0272 |
Bitewings - two radiographic images |
3,404 |
3,071 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
878 |
499 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
4,464 |
3,889 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,192 |
380 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
805 |
280 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,144 |
2,854 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,261 |
1,999 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,036 |
3,554 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
530 |
508 |
$43K |
| D1110 |
Prophylaxis - adult |
863 |
775 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
866 |
780 |
$28K |
| D1351 |
Sealant - per tooth |
948 |
267 |
$23K |
| D2330 |
|
281 |
134 |
$21K |
| D1206 |
Topical application of fluoride varnish |
872 |
795 |
$16K |
| D0603 |
|
2,893 |
2,613 |
$13K |
| D7111 |
|
134 |
66 |
$6K |
| D0330 |
Panoramic radiographic image |
374 |
359 |
$4K |
| D1510 |
|
19 |
15 |
$3K |
| D0601 |
|
169 |
122 |
$775.00 |
| D0602 |
|
31 |
18 |
$135.00 |