| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,264 |
2,655 |
$1.84M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,332 |
1,889 |
$641K |
| D7240 |
Removal of impacted tooth - completely bony |
1,837 |
569 |
$502K |
| D2934 |
|
1,519 |
496 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,030 |
458 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,598 |
2,585 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
970 |
401 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
917 |
440 |
$96K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
314 |
293 |
$90K |
| D1120 |
Prophylaxis - child |
2,263 |
2,257 |
$76K |
| D1206 |
Topical application of fluoride varnish |
2,167 |
2,158 |
$40K |
| D9222 |
|
301 |
291 |
$28K |
| D0272 |
Bitewings - two radiographic images |
874 |
873 |
$19K |
| D9219 |
|
334 |
316 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
551 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
350 |
350 |
$5K |
| D1351 |
Sealant - per tooth |
120 |
37 |
$4K |
| D0350 |
|
98 |
52 |
$4K |
| D7961 |
|
12 |
12 |
$2K |
| D1510 |
|
15 |
13 |
$2K |
| D9243 |
|
12 |
12 |
$2K |
| D2330 |
|
18 |
12 |
$2K |
| D9239 |
|
12 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$272.52 |