| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28,092 |
5,787 |
$3.35M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12,716 |
4,104 |
$1.14M |
| D1120 |
Prophylaxis - child |
23,631 |
23,286 |
$717K |
| D2932 |
|
4,022 |
1,181 |
$582K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,500 |
3,669 |
$560K |
| D3230 |
|
4,412 |
1,288 |
$433K |
| D0120 |
Periodic oral evaluation - established patient |
20,206 |
19,913 |
$429K |
| D1206 |
Topical application of fluoride varnish |
23,988 |
23,647 |
$403K |
| D9248 |
|
3,002 |
2,959 |
$401K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,057 |
1,539 |
$316K |
| D0272 |
Bitewings - two radiographic images |
13,212 |
13,026 |
$240K |
| D1351 |
Sealant - per tooth |
8,437 |
2,489 |
$202K |
| D9310 |
|
3,114 |
3,082 |
$151K |
| D0330 |
Panoramic radiographic image |
3,127 |
3,093 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,392 |
1,332 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,435 |
4,367 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
7,963 |
7,838 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,470 |
3,409 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,828 |
3,751 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,156 |
5,989 |
$46K |
| D2330 |
|
509 |
337 |
$30K |
| D1110 |
Prophylaxis - adult |
617 |
613 |
$28K |
| D2331 |
|
186 |
104 |
$17K |
| D2929 |
|
97 |
26 |
$12K |
| D7111 |
|
49 |
28 |
$3K |
| D0274 |
Bitewings - four radiographic images |
81 |
81 |
$2K |
| D2920 |
|
54 |
43 |
$2K |
| D3120 |
|
18 |
12 |
$549.00 |