| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,525 |
1,820 |
$900K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,733 |
1,134 |
$761K |
| D1120 |
Prophylaxis - child |
9,223 |
9,199 |
$411K |
| D0120 |
Periodic oral evaluation - established patient |
5,114 |
5,097 |
$341K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,541 |
3,535 |
$242K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,753 |
1,676 |
$215K |
| D1310 |
|
6,384 |
6,367 |
$202K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,655 |
1,620 |
$177K |
| D1206 |
Topical application of fluoride varnish |
8,900 |
8,876 |
$176K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,573 |
3,300 |
$143K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,416 |
602 |
$140K |
| D9222 |
|
1,132 |
1,132 |
$138K |
| D1351 |
Sealant - per tooth |
3,650 |
1,355 |
$119K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,798 |
1,798 |
$117K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,833 |
6,478 |
$111K |
| D9610 |
|
2,159 |
1,223 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,491 |
990 |
$80K |
| D0272 |
Bitewings - two radiographic images |
5,566 |
5,548 |
$66K |
| D9221 |
|
243 |
159 |
$62K |
| D0603 |
|
3,495 |
3,482 |
$51K |
| D1510 |
|
205 |
156 |
$39K |
| D9220 |
|
160 |
160 |
$38K |
| D0350 |
|
3,931 |
2,118 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,319 |
2,296 |
$28K |
| D9430 |
|
736 |
722 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
322 |
183 |
$22K |
| D0602 |
|
779 |
778 |
$11K |
| D2330 |
|
100 |
54 |
$8K |
| D2140 |
|
80 |
50 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
191 |
$3K |
| D0274 |
Bitewings - four radiographic images |
81 |
81 |
$2K |
| D2331 |
|
18 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1354 |
|
129 |
35 |
$948.00 |
| D0270 |
|
15 |
15 |
$75.00 |
| D9310 |
|
110 |
110 |
$0.00 |
| D9993 |
|
1,835 |
1,834 |
$0.00 |