| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,791 |
1,383 |
$670K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,214 |
1,284 |
$206K |
| D1120 |
Prophylaxis - child |
5,059 |
4,867 |
$149K |
| D1206 |
Topical application of fluoride varnish |
5,501 |
5,297 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
4,192 |
4,014 |
$85K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
323 |
311 |
$81K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
835 |
392 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,625 |
4,431 |
$68K |
| D2390 |
|
326 |
115 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,052 |
1,983 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,791 |
1,683 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,907 |
3,411 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,961 |
1,888 |
$34K |
| D1351 |
Sealant - per tooth |
1,224 |
437 |
$29K |
| D9222 |
|
322 |
311 |
$25K |
| D0330 |
Panoramic radiographic image |
530 |
516 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
153 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
397 |
257 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
697 |
684 |
$21K |
| D9310 |
|
412 |
404 |
$20K |
| D1110 |
Prophylaxis - adult |
285 |
279 |
$12K |
| D9610 |
|
327 |
316 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
104 |
104 |
$3K |
| D1354 |
|
25 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
83 |
83 |
$1K |
| D0240 |
|
33 |
33 |
$603.90 |