| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,738 |
6,819 |
$1.63M |
| D1120 |
Prophylaxis - child |
31,075 |
30,694 |
$1.03M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
11,719 |
5,770 |
$927K |
| D0120 |
Periodic oral evaluation - established patient |
37,404 |
36,962 |
$895K |
| D1206 |
Topical application of fluoride varnish |
22,981 |
22,711 |
$469K |
| D9248 |
|
4,982 |
4,816 |
$425K |
| D0330 |
Panoramic radiographic image |
8,771 |
8,641 |
$407K |
| D2140 |
|
6,771 |
4,562 |
$390K |
| D1351 |
Sealant - per tooth |
13,420 |
4,084 |
$389K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,692 |
18,461 |
$385K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,886 |
10,943 |
$284K |
| D1110 |
Prophylaxis - adult |
6,661 |
6,578 |
$282K |
| D0272 |
Bitewings - two radiographic images |
15,483 |
15,324 |
$274K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,574 |
2,962 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,887 |
6,801 |
$201K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,565 |
1,977 |
$180K |
| D1353 |
|
4,124 |
1,131 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
3,088 |
3,020 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
3,672 |
3,568 |
$44K |
| D2330 |
|
202 |
132 |
$10K |
| D1354 |
|
360 |
234 |
$3K |
| D2920 |
|
12 |
12 |
$526.56 |
| D2940 |
|
72 |
66 |
$395.35 |