| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,596 |
1,876 |
$1.41M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,468 |
1,009 |
$1.08M |
| D2933 |
|
1,684 |
545 |
$390K |
| D1120 |
Prophylaxis - child |
7,002 |
6,708 |
$298K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,102 |
1,393 |
$259K |
| D9222 |
|
951 |
936 |
$238K |
| D1206 |
Topical application of fluoride varnish |
6,774 |
6,498 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
4,773 |
4,582 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,462 |
991 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,554 |
3,074 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
922 |
654 |
$126K |
| D1351 |
Sealant - per tooth |
3,258 |
1,106 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
1,930 |
1,848 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
4,718 |
4,495 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,928 |
1,727 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,532 |
1,478 |
$76K |
| D0330 |
Panoramic radiographic image |
1,047 |
1,005 |
$76K |
| D0272 |
Bitewings - two radiographic images |
2,106 |
2,048 |
$69K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
546 |
352 |
$67K |
| D1510 |
|
206 |
147 |
$46K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,261 |
1,200 |
$44K |
| D0274 |
Bitewings - four radiographic images |
704 |
695 |
$27K |
| D9248 |
|
137 |
130 |
$27K |
| D2330 |
|
235 |
151 |
$24K |
| D2934 |
|
79 |
21 |
$17K |
| D2929 |
|
28 |
14 |
$8K |
| D7111 |
|
81 |
50 |
$6K |
| D1110 |
Prophylaxis - adult |
76 |
75 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
143 |
105 |
$3K |
| D1354 |
|
159 |
53 |
$2K |
| D2940 |
|
17 |
12 |
$1K |