| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,622 |
1,715 |
$792K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,815 |
1,737 |
$145K |
| D9420 |
|
2,250 |
2,063 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
2,263 |
2,076 |
$37K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
557 |
496 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
3,208 |
2,917 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,274 |
2,086 |
$19K |
| D2330 |
|
759 |
401 |
$17K |
| D9222 |
|
559 |
497 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
607 |
317 |
$11K |
| D1351 |
Sealant - per tooth |
5,748 |
1,268 |
$11K |
| D2335 |
|
190 |
61 |
$9K |
| D2934 |
|
145 |
55 |
$8K |
| D2331 |
|
172 |
85 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
139 |
82 |
$3K |
| D0603 |
|
3,925 |
3,436 |
$3K |
| D0350 |
|
1,025 |
894 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
31 |
$1K |
| D1330 |
|
2,259 |
2,073 |
$1K |
| D3120 |
|
118 |
61 |
$179.36 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D9612 |
|
559 |
497 |
$0.00 |