| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,131 |
2,254 |
$1.21M |
| D7140 |
Extraction, erupted tooth or exposed root |
4,437 |
1,814 |
$292K |
| D1120 |
Prophylaxis - child |
9,030 |
8,786 |
$274K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,311 |
1,081 |
$207K |
| D1354 |
|
2,882 |
756 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
8,555 |
8,308 |
$182K |
| D1206 |
Topical application of fluoride varnish |
10,089 |
9,806 |
$175K |
| D0272 |
Bitewings - two radiographic images |
5,348 |
5,232 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,580 |
3,506 |
$96K |
| D1351 |
Sealant - per tooth |
3,229 |
1,058 |
$78K |
| D7962 |
|
298 |
273 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,825 |
3,715 |
$57K |
| D0330 |
Panoramic radiographic image |
1,072 |
1,043 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
409 |
238 |
$47K |
| D9310 |
|
958 |
954 |
$46K |
| D1110 |
Prophylaxis - adult |
902 |
866 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
642 |
391 |
$38K |
| D2934 |
|
249 |
91 |
$36K |
| D9248 |
|
246 |
239 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
811 |
792 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,424 |
1,316 |
$18K |
| D2332 |
|
151 |
81 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
482 |
472 |
$15K |
| D2330 |
|
142 |
76 |
$9K |
| D9610 |
|
110 |
110 |
$3K |
| D0274 |
Bitewings - four radiographic images |
93 |
77 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
83 |
82 |
$3K |
| D3120 |
|
18 |
12 |
$426.86 |