| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,800 |
1,865 |
$1.23M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,125 |
1,413 |
$405K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,612 |
2,568 |
$352K |
| D1351 |
Sealant - per tooth |
12,483 |
3,231 |
$324K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,202 |
1,821 |
$308K |
| D1120 |
Prophylaxis - child |
7,949 |
7,824 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
9,359 |
9,180 |
$261K |
| D0272 |
Bitewings - two radiographic images |
9,306 |
8,978 |
$201K |
| D0220 |
Intraoral - periapical first radiographic image |
15,149 |
14,641 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,285 |
12,440 |
$147K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
263 |
254 |
$145K |
| D2934 |
|
1,082 |
348 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,035 |
9,891 |
$143K |
| D1110 |
Prophylaxis - adult |
2,143 |
2,099 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,460 |
928 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,258 |
3,160 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,362 |
3,207 |
$84K |
| D9248 |
|
793 |
769 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,013 |
1,966 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,124 |
643 |
$62K |
| D2330 |
|
549 |
274 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,874 |
1,823 |
$32K |
| D0330 |
Panoramic radiographic image |
496 |
491 |
$24K |
| D2931 |
|
163 |
144 |
$22K |
| D2950 |
|
443 |
396 |
$17K |
| D0270 |
|
1,337 |
1,272 |
$6K |
| D1206 |
Topical application of fluoride varnish |
351 |
327 |
$5K |
| D0160 |
|
279 |
277 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
37 |
$2K |
| D0170 |
|
128 |
127 |
$2K |
| D7111 |
|
16 |
13 |
$183.52 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
56 |
22 |
$87.76 |
| D3120 |
|
15 |
15 |
$28.67 |
| D0603 |
|
18,400 |
17,947 |
$0.00 |
| D9222 |
|
35 |
35 |
$0.00 |