| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35,012 |
6,777 |
$4.12M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21,015 |
5,660 |
$2.08M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
7,929 |
5,315 |
$1.95M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,689 |
4,887 |
$953K |
| D9221 |
|
3,290 |
3,070 |
$902K |
| D9420 |
|
10,950 |
8,539 |
$840K |
| D9610 |
|
13,009 |
8,496 |
$714K |
| D9220 |
|
3,093 |
3,086 |
$668K |
| D9222 |
|
5,313 |
5,312 |
$635K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,606 |
3,356 |
$579K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
5,585 |
5,412 |
$571K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,984 |
6,954 |
$436K |
| D2330 |
|
4,396 |
2,143 |
$342K |
| D1510 |
|
1,621 |
1,099 |
$262K |
| D0350 |
|
27,935 |
7,308 |
$258K |
| D0230 |
Intraoral - periapical each additional radiographic image |
63,025 |
8,475 |
$255K |
| 0360 |
|
2,066 |
1,517 |
$225K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
1,895 |
1,803 |
$192K |
| 99199 |
Unlisted special service, procedure or report |
3,649 |
835 |
$160K |
| D1120 |
Prophylaxis - child |
3,836 |
3,817 |
$138K |
| D2140 |
|
2,453 |
1,389 |
$134K |
| D1351 |
Sealant - per tooth |
4,160 |
1,476 |
$133K |
| G0330 |
Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room |
60 |
60 |
$120K |
| D0272 |
Bitewings - two radiographic images |
7,971 |
7,941 |
$94K |
| 99218 |
|
3,170 |
1,496 |
$94K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
2,739 |
1,803 |
$79K |
| 0490 |
|
1,211 |
1,162 |
$61K |
| 0760 |
|
1,587 |
1,504 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,040 |
3,024 |
$58K |
| J2704 |
Injection, propofol, 10 mg |
3,582 |
3,462 |
$56K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
5,514 |
5,263 |
$43K |
| 0710 |
|
1,573 |
1,523 |
$34K |
| 99221 |
|
620 |
308 |
$17K |
| 99236 |
Prolong inpt eval add15 m |
123 |
120 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
143 |
143 |
$7K |
| 0160 |
|
136 |
134 |
$6K |
| Z7506 |
|
61 |
61 |
$5K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
772 |
766 |
$4K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
593 |
576 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
282 |
281 |
$2K |
| J3490 |
Unclassified drugs |
318 |
57 |
$2K |
| Z7514 |
|
34 |
34 |
$1K |
| 99217 |
|
119 |
117 |
$1K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
212 |
165 |
$1K |
| Z7512 |
|
61 |
61 |
$983.30 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$885.00 |
| 99205 |
Prolong outpt/office vis |
121 |
118 |
$839.44 |
| 0700 |
|
103 |
103 |
$829.92 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
174 |
155 |
$790.32 |
| Z7500 |
|
34 |
34 |
$740.66 |
| 36430 |
|
13 |
13 |
$529.88 |
| Z7508 |
|
12 |
12 |
$449.19 |
| 99219 |
|
119 |
117 |
$435.64 |
| D9430 |
|
12 |
12 |
$384.00 |
| J7642 |
Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram |
30 |
15 |
$0.00 |