| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,416 |
848 |
$1.01M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,044 |
806 |
$502K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,598 |
1,613 |
$295K |
| D9420 |
|
695 |
653 |
$164K |
| D1120 |
Prophylaxis - child |
6,152 |
5,915 |
$122K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,696 |
939 |
$92K |
| D2330 |
|
1,156 |
327 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
5,294 |
5,077 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,116 |
2,871 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,234 |
4,999 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,598 |
2,461 |
$44K |
| D9310 |
|
723 |
705 |
$41K |
| D1510 |
|
196 |
129 |
$34K |
| D0272 |
Bitewings - two radiographic images |
4,809 |
4,579 |
$31K |
| D2140 |
|
413 |
188 |
$29K |
| D0240 |
|
3,817 |
1,970 |
$27K |
| D1351 |
Sealant - per tooth |
3,828 |
1,281 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
114 |
53 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
2,642 |
2,523 |
$18K |
| D0330 |
Panoramic radiographic image |
1,410 |
1,365 |
$13K |
| D1110 |
Prophylaxis - adult |
703 |
692 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,233 |
2,146 |
$10K |
| D0602 |
|
7,361 |
7,174 |
$9K |
| D1206 |
Topical application of fluoride varnish |
3,273 |
3,187 |
$9K |
| D9630 |
|
1,989 |
1,936 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
630 |
228 |
$7K |
| D7510 |
|
39 |
18 |
$5K |
| D2331 |
|
49 |
27 |
$5K |
| D1354 |
|
14,052 |
3,319 |
$3K |
| D1999 |
|
1,377 |
1,289 |
$763.00 |
| D9440 |
|
14 |
14 |
$737.36 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$696.00 |
| D0170 |
|
26 |
26 |
$365.48 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$199.00 |
| D0603 |
|
163 |
161 |
$164.25 |
| D9996 |
|
32 |
32 |
$151.20 |
| D0601 |
|
3,082 |
2,897 |
$117.75 |
| D1330 |
|
4,471 |
3,809 |
$76.81 |
| D0191 |
|
3,675 |
3,643 |
$52.51 |
| D0270 |
|
148 |
146 |
$28.50 |
| D9920 |
|
20,933 |
18,839 |
$14.97 |
| D9995 |
|
23 |
21 |
$1.00 |
| D1310 |
|
16,631 |
15,631 |
$0.00 |
| D9215 |
|
3,079 |
2,843 |
$0.00 |
| D0171 |
|
257 |
247 |
$0.00 |
| D9992 |
|
19 |
19 |
$0.00 |