| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,268 |
1,118 |
$505K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
1,261 |
1,259 |
$451K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
613 |
596 |
$295K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,502 |
968 |
$163K |
| D2390 |
|
738 |
238 |
$150K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,357 |
679 |
$121K |
| D9248 |
|
770 |
767 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,550 |
697 |
$90K |
| D1120 |
Prophylaxis - child |
2,130 |
2,105 |
$64K |
| D9310 |
|
1,162 |
1,158 |
$56K |
| D9222 |
|
613 |
596 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
389 |
177 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,548 |
1,525 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,173 |
2,144 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,720 |
1,708 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,429 |
1,387 |
$22K |
| D2330 |
|
312 |
192 |
$19K |
| D9610 |
|
609 |
592 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
231 |
$7K |
| D3221 |
|
38 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
447 |
342 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
77 |
$2K |