| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,731 |
2,828 |
$1.95M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
5,458 |
2,517 |
$1.24M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,021 |
1,479 |
$388K |
| D9420 |
|
5,614 |
3,435 |
$375K |
| D9222 |
|
2,518 |
2,518 |
$300K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,071 |
1,640 |
$283K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,112 |
4,091 |
$266K |
| D1310 |
|
3,047 |
3,035 |
$124K |
| D9610 |
|
5,192 |
3,162 |
$114K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,081 |
4,331 |
$106K |
| D1120 |
Prophylaxis - child |
2,008 |
1,978 |
$78K |
| D0350 |
|
5,181 |
2,281 |
$63K |
| D2330 |
|
704 |
361 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
732 |
319 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
700 |
339 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
817 |
437 |
$43K |
| D3230 |
|
425 |
163 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,550 |
3,485 |
$40K |
| D0603 |
|
3,024 |
3,012 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,985 |
1,958 |
$38K |
| D1351 |
Sealant - per tooth |
1,005 |
378 |
$35K |
| D2140 |
|
592 |
289 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
234 |
233 |
$13K |
| D9920 |
|
86 |
86 |
$11K |
| D2331 |
|
127 |
79 |
$10K |
| D1510 |
|
38 |
27 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
29 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
144 |
$2K |
| D2332 |
|
22 |
14 |
$2K |
| D3120 |
|
53 |
32 |
$0.00 |