| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,750 |
4,090 |
$1.59M |
| D9248 |
|
4,000 |
3,918 |
$522K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,718 |
3,117 |
$453K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,676 |
2,629 |
$264K |
| D1351 |
Sealant - per tooth |
3,476 |
2,254 |
$230K |
| D2934 |
|
1,220 |
777 |
$161K |
| D1120 |
Prophylaxis - child |
3,888 |
3,788 |
$138K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,332 |
2,163 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,513 |
1,127 |
$112K |
| D1510 |
|
1,329 |
1,167 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,525 |
4,321 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,854 |
1,424 |
$95K |
| D1206 |
Topical application of fluoride varnish |
3,665 |
3,578 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,540 |
4,006 |
$59K |
| D1354 |
|
1,246 |
912 |
$37K |
| D3230 |
|
354 |
226 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,218 |
1,206 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,517 |
4,328 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
1,256 |
1,164 |
$23K |
| D2330 |
|
312 |
257 |
$18K |
| D0330 |
Panoramic radiographic image |
952 |
883 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,347 |
1,300 |
$18K |
| D0272 |
Bitewings - two radiographic images |
771 |
746 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
269 |
251 |
$6K |
| D2332 |
|
46 |
40 |
$4K |
| D0274 |
Bitewings - four radiographic images |
332 |
314 |
$4K |
| D0603 |
|
71 |
62 |
$0.00 |