| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,109 |
2,648 |
$1.75M |
| D0240 |
|
38,757 |
19,733 |
$926K |
| D0120 |
Periodic oral evaluation - established patient |
25,282 |
23,691 |
$652K |
| D1120 |
Prophylaxis - child |
18,344 |
17,179 |
$637K |
| D1206 |
Topical application of fluoride varnish |
26,286 |
24,655 |
$509K |
| D0272 |
Bitewings - two radiographic images |
21,496 |
20,161 |
$487K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,995 |
1,676 |
$407K |
| D1110 |
Prophylaxis - adult |
7,746 |
7,280 |
$354K |
| D9248 |
|
2,414 |
2,207 |
$212K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,120 |
1,196 |
$209K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,963 |
6,311 |
$173K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,144 |
1,087 |
$165K |
| D2140 |
|
2,653 |
1,618 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
944 |
895 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,649 |
3,295 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,666 |
1,527 |
$53K |
| D0603 |
|
11,946 |
10,694 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,333 |
2,220 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
352 |
136 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
522 |
$15K |
| D0330 |
Panoramic radiographic image |
217 |
213 |
$4K |
| D2330 |
|
50 |
25 |
$3K |