| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12,142 |
1,903 |
$1.73M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,588 |
756 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
3,906 |
3,877 |
$110K |
| D0272 |
Bitewings - two radiographic images |
5,054 |
5,000 |
$110K |
| D1351 |
Sealant - per tooth |
3,357 |
1,071 |
$92K |
| D1110 |
Prophylaxis - adult |
1,725 |
1,717 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,419 |
689 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,107 |
580 |
$81K |
| D9248 |
|
666 |
648 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
6,434 |
6,279 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,926 |
5,817 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,993 |
1,960 |
$68K |
| D1120 |
Prophylaxis - child |
1,729 |
1,716 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
583 |
358 |
$57K |
| D9420 |
|
1,561 |
1,522 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,569 |
3,546 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
588 |
377 |
$48K |
| D0145 |
Oral evaluation for a patient under three years of age |
296 |
295 |
$41K |
| D2140 |
|
591 |
394 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,279 |
1,268 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
836 |
813 |
$22K |
| D3230 |
|
457 |
201 |
$16K |
| D2934 |
|
76 |
26 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
57 |
$3K |
| D0330 |
Panoramic radiographic image |
131 |
130 |
$3K |
| D7111 |
|
264 |
152 |
$3K |
| D0270 |
|
16 |
13 |
$68.60 |
| D0603 |
|
6,623 |
6,553 |
$0.00 |