| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,755 |
3,068 |
$1.86M |
| D7140 |
Extraction, erupted tooth or exposed root |
4,970 |
2,091 |
$326K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,997 |
1,479 |
$240K |
| D1120 |
Prophylaxis - child |
7,775 |
7,748 |
$195K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,220 |
6,197 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
5,310 |
5,292 |
$115K |
| D0140 |
Limited oral evaluation - problem focused |
3,588 |
3,558 |
$102K |
| D0272 |
Bitewings - two radiographic images |
6,182 |
6,144 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,322 |
2,317 |
$77K |
| D1351 |
Sealant - per tooth |
3,037 |
957 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,089 |
2,027 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
749 |
552 |
$47K |
| D2335 |
|
386 |
157 |
$46K |
| D1510 |
|
254 |
181 |
$36K |
| D9248 |
|
346 |
336 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,443 |
3,395 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,208 |
1,208 |
$18K |
| D2330 |
|
255 |
146 |
$16K |
| D9222 |
|
122 |
115 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
235 |
168 |
$16K |
| D2140 |
|
185 |
111 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
87 |
82 |
$7K |
| D2331 |
|
74 |
54 |
$6K |
| D0274 |
Bitewings - four radiographic images |
140 |
140 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
30 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
372 |
289 |
$2K |
| D1110 |
Prophylaxis - adult |
32 |
31 |
$1K |