| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,053 |
5,264 |
$1.87M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15,869 |
5,017 |
$1.55M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,154 |
5,857 |
$794K |
| D1120 |
Prophylaxis - child |
19,933 |
19,816 |
$767K |
| D0120 |
Periodic oral evaluation - established patient |
12,667 |
12,625 |
$748K |
| D2335 |
|
6,134 |
2,190 |
$710K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,534 |
3,621 |
$686K |
| D2160 |
|
7,313 |
3,013 |
$571K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,551 |
3,199 |
$499K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,761 |
7,728 |
$495K |
| D1310 |
|
10,290 |
10,245 |
$460K |
| D2330 |
|
4,403 |
1,657 |
$330K |
| D1351 |
Sealant - per tooth |
10,158 |
3,012 |
$282K |
| D9993 |
|
4,612 |
4,609 |
$278K |
| D9248 |
|
7,957 |
7,897 |
$276K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62,551 |
24,331 |
$260K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,249 |
14,193 |
$225K |
| D1510 |
|
1,360 |
994 |
$220K |
| D0272 |
Bitewings - two radiographic images |
15,960 |
15,874 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,394 |
1,324 |
$180K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,574 |
2,561 |
$161K |
| D0350 |
|
9,649 |
4,992 |
$133K |
| D2332 |
|
1,419 |
666 |
$110K |
| D0330 |
Panoramic radiographic image |
3,449 |
3,434 |
$101K |
| D1206 |
Topical application of fluoride varnish |
5,404 |
5,358 |
$90K |
| D0603 |
|
5,921 |
5,895 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
7,142 |
7,055 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,894 |
1,859 |
$72K |
| D0274 |
Bitewings - four radiographic images |
3,273 |
3,260 |
$68K |
| D0602 |
|
2,342 |
2,339 |
$35K |
| D2933 |
|
228 |
75 |
$24K |
| D9430 |
|
648 |
628 |
$20K |
| D0601 |
|
1,288 |
1,285 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
238 |
91 |
$19K |