| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43,826 |
6,603 |
$6.47M |
| D9420 |
|
7,465 |
7,348 |
$903K |
| D0120 |
Periodic oral evaluation - established patient |
14,278 |
14,098 |
$370K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,320 |
1,716 |
$350K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
703 |
681 |
$304K |
| D1120 |
Prophylaxis - child |
10,343 |
10,197 |
$285K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,605 |
742 |
$279K |
| D1206 |
Topical application of fluoride varnish |
14,195 |
13,968 |
$229K |
| D1110 |
Prophylaxis - adult |
5,087 |
5,023 |
$195K |
| D2932 |
|
1,034 |
280 |
$179K |
| D2933 |
|
797 |
197 |
$144K |
| D0240 |
|
7,487 |
3,775 |
$124K |
| D0272 |
Bitewings - two radiographic images |
6,201 |
6,128 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,571 |
1,458 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,106 |
2,071 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
792 |
362 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,341 |
1,305 |
$60K |
| D1351 |
Sealant - per tooth |
1,930 |
558 |
$54K |
| D9222 |
|
704 |
681 |
$43K |
| D0330 |
Panoramic radiographic image |
464 |
451 |
$22K |
| D2934 |
|
106 |
24 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
809 |
781 |
$12K |
| D0160 |
|
140 |
140 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
67 |
$9K |
| D9248 |
|
662 |
621 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
514 |
509 |
$8K |
| D3230 |
|
65 |
16 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
40 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
149 |
$5K |
| D2330 |
|
59 |
29 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
160 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$1K |
| D1354 |
|
35 |
12 |
$167.41 |