| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,633 |
1,895 |
$1.63M |
| D1351 |
Sealant - per tooth |
19,540 |
3,514 |
$660K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
959 |
905 |
$444K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,378 |
1,602 |
$424K |
| D1120 |
Prophylaxis - child |
8,406 |
8,233 |
$366K |
| D1206 |
Topical application of fluoride varnish |
12,286 |
12,045 |
$318K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,626 |
967 |
$301K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,706 |
1,480 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
8,158 |
8,008 |
$282K |
| D1110 |
Prophylaxis - adult |
3,796 |
3,727 |
$223K |
| D0210 |
Intraoral - complete series of radiographic images |
2,060 |
2,033 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,266 |
4,199 |
$211K |
| D2140 |
|
2,394 |
1,427 |
$197K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,866 |
1,036 |
$186K |
| D9222 |
|
977 |
919 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
997 |
593 |
$129K |
| D9420 |
|
644 |
637 |
$109K |
| D0272 |
Bitewings - two radiographic images |
3,494 |
3,400 |
$108K |
| D2330 |
|
970 |
563 |
$98K |
| D2934 |
|
377 |
105 |
$97K |
| D0274 |
Bitewings - four radiographic images |
1,885 |
1,855 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
1,384 |
1,329 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,609 |
1,940 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
3,285 |
3,140 |
$61K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,512 |
1,482 |
$58K |
| D2160 |
|
427 |
301 |
$51K |
| D0240 |
|
2,552 |
1,324 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,153 |
1,083 |
$46K |
| D0603 |
|
3,145 |
3,060 |
$32K |
| D1510 |
|
166 |
106 |
$29K |
| D2331 |
|
181 |
91 |
$22K |
| D1330 |
|
865 |
845 |
$21K |
| D1354 |
|
1,127 |
333 |
$15K |
| D7961 |
|
28 |
28 |
$7K |
| D2940 |
|
111 |
39 |
$5K |
| D2332 |
|
18 |
16 |
$3K |
| D7111 |
|
39 |
12 |
$3K |
| D0601 |
|
306 |
302 |
$2K |
| D0602 |
|
231 |
219 |
$1K |
| D1353 |
|
66 |
28 |
$330.70 |