| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19,093 |
3,835 |
$2.08M |
| D7140 |
Extraction, erupted tooth or exposed root |
11,001 |
3,774 |
$545K |
| D1120 |
Prophylaxis - child |
17,219 |
14,499 |
$396K |
| D9248 |
|
3,594 |
2,929 |
$353K |
| D0210 |
Intraoral - complete series of radiographic images |
7,950 |
6,980 |
$353K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,423 |
8,724 |
$236K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,460 |
1,407 |
$229K |
| D0120 |
Periodic oral evaluation - established patient |
11,751 |
9,847 |
$193K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,845 |
2,759 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,351 |
8,019 |
$132K |
| D0274 |
Bitewings - four radiographic images |
7,396 |
5,825 |
$130K |
| D1351 |
Sealant - per tooth |
5,350 |
1,646 |
$96K |
| D1206 |
Topical application of fluoride varnish |
6,623 |
6,250 |
$90K |
| D9243 |
|
933 |
432 |
$78K |
| D1510 |
|
660 |
392 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
885 |
375 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
2,279 |
2,000 |
$46K |
| D0330 |
Panoramic radiographic image |
1,372 |
1,161 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,502 |
3,084 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,071 |
513 |
$41K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
261 |
91 |
$38K |
| D9239 |
|
523 |
440 |
$23K |
| D9222 |
|
108 |
92 |
$17K |
| D2934 |
|
111 |
12 |
$7K |
| D1354 |
|
146 |
37 |
$915.90 |
| D2920 |
|
32 |
24 |
$817.37 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$377.70 |