| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,135 |
4,341 |
$1.08M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
9,041 |
4,280 |
$894K |
| D0120 |
Periodic oral evaluation - established patient |
12,432 |
12,387 |
$640K |
| D1120 |
Prophylaxis - child |
14,907 |
14,860 |
$559K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,390 |
4,032 |
$402K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,388 |
3,694 |
$365K |
| D0230 |
Intraoral - periapical each additional radiographic image |
77,688 |
15,934 |
$352K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,610 |
7,000 |
$298K |
| D1351 |
Sealant - per tooth |
9,843 |
3,530 |
$273K |
| D2140 |
|
3,839 |
2,176 |
$208K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,741 |
1,959 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,122 |
16,069 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,686 |
2,681 |
$167K |
| D0350 |
|
16,776 |
8,517 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,821 |
1,285 |
$122K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,011 |
1,011 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,998 |
1,981 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,596 |
1,589 |
$19K |
| D1510 |
|
56 |
50 |
$4K |