| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,456 |
1,469 |
$1.27M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,059 |
2,337 |
$517K |
| D1120 |
Prophylaxis - child |
13,191 |
13,181 |
$515K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,459 |
1,948 |
$277K |
| D1110 |
Prophylaxis - adult |
4,747 |
4,735 |
$230K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,164 |
10,155 |
$225K |
| D0140 |
Limited oral evaluation - problem focused |
4,688 |
4,559 |
$203K |
| D1351 |
Sealant - per tooth |
5,425 |
1,059 |
$161K |
| D2140 |
|
2,395 |
1,528 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
5,874 |
5,835 |
$151K |
| D9420 |
|
760 |
749 |
$146K |
| D0272 |
Bitewings - two radiographic images |
5,183 |
5,163 |
$111K |
| D0191 |
|
5,712 |
5,710 |
$109K |
| D1206 |
Topical application of fluoride varnish |
3,823 |
3,821 |
$108K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
142 |
129 |
$97K |
| D0330 |
Panoramic radiographic image |
1,285 |
1,278 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,625 |
2,608 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
4,451 |
4,268 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,234 |
1,231 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
714 |
707 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
95 |
$20K |
| D2160 |
|
231 |
166 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,490 |
897 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
74 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
18 |
12 |
$10K |
| D1510 |
|
52 |
37 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
25 |
$5K |
| D1354 |
|
221 |
37 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
81 |
81 |
$3K |
| D2950 |
|
15 |
12 |
$2K |
| D0603 |
|
82 |
81 |
$0.00 |