| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,379 |
1,231 |
$750K |
| D1120 |
Prophylaxis - child |
9,330 |
8,964 |
$277K |
| D0120 |
Periodic oral evaluation - established patient |
8,604 |
8,261 |
$179K |
| D1206 |
Topical application of fluoride varnish |
9,157 |
8,784 |
$158K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
556 |
556 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,196 |
1,111 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
7,939 |
7,528 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
771 |
454 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,986 |
6,227 |
$82K |
| D1351 |
Sealant - per tooth |
3,017 |
791 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,167 |
2,051 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,191 |
3,067 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,780 |
1,713 |
$53K |
| D9310 |
|
934 |
926 |
$45K |
| D9222 |
|
555 |
555 |
$43K |
| D2390 |
|
218 |
64 |
$43K |
| D0330 |
Panoramic radiographic image |
814 |
812 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
493 |
333 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
333 |
174 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
889 |
869 |
$26K |
| D1110 |
Prophylaxis - adult |
498 |
476 |
$21K |
| D9610 |
|
552 |
552 |
$17K |
| D0274 |
Bitewings - four radiographic images |
547 |
516 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
401 |
379 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
496 |
496 |
$7K |
| D7111 |
|
77 |
44 |
$5K |
| D2331 |
|
24 |
12 |
$2K |