| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,262 |
5,008 |
$1.13M |
| D1120 |
Prophylaxis - child |
25,530 |
23,744 |
$1.01M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,218 |
1,133 |
$702K |
| D0120 |
Periodic oral evaluation - established patient |
22,749 |
21,132 |
$620K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,369 |
21,802 |
$584K |
| D1351 |
Sealant - per tooth |
8,730 |
4,471 |
$471K |
| D9110 |
|
8,001 |
7,607 |
$433K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,551 |
4,666 |
$421K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,447 |
9,345 |
$384K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,526 |
21,647 |
$310K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,901 |
4,052 |
$295K |
| D1354 |
|
7,243 |
4,902 |
$265K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,916 |
2,229 |
$242K |
| D9222 |
|
1,201 |
1,120 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,539 |
6,985 |
$162K |
| D0220 |
Intraoral - periapical first radiographic image |
26,545 |
24,167 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,688 |
3,037 |
$139K |
| D1510 |
|
1,680 |
1,358 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
3,988 |
3,695 |
$66K |
| D2335 |
|
375 |
274 |
$55K |
| D2330 |
|
726 |
581 |
$38K |
| D0330 |
Panoramic radiographic image |
1,667 |
1,612 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,903 |
1,806 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,209 |
2,162 |
$21K |
| D8670 |
Periodic orthodontic treatment visit |
96 |
85 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
97 |
$10K |
| D9995 |
|
705 |
595 |
$8K |
| D2332 |
|
39 |
37 |
$6K |
| D2331 |
|
62 |
54 |
$5K |
| D9310 |
|
278 |
273 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
240 |
$2K |
| D8999 |
|
38 |
38 |
$2K |
| D1206 |
Topical application of fluoride varnish |
18 |
12 |
$416.00 |
| D2940 |
|
36 |
33 |
$237.30 |
| D0601 |
|
1,061 |
938 |
$0.09 |
| D0602 |
|
442 |
397 |
$0.03 |
| D0603 |
|
78 |
64 |
$0.00 |