| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,258 |
775 |
$385K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
733 |
727 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,872 |
703 |
$213K |
| D1120 |
Prophylaxis - child |
4,801 |
4,617 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,752 |
708 |
$114K |
| D1206 |
Topical application of fluoride varnish |
5,053 |
4,859 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,958 |
2,830 |
$61K |
| D9222 |
|
732 |
727 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,665 |
3,501 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,748 |
1,688 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,365 |
2,982 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
631 |
398 |
$37K |
| D1351 |
Sealant - per tooth |
1,555 |
586 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,665 |
1,606 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,111 |
989 |
$29K |
| D0330 |
Panoramic radiographic image |
489 |
472 |
$23K |
| D9610 |
|
730 |
725 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
667 |
$20K |
| D9310 |
|
389 |
386 |
$18K |
| D1510 |
|
153 |
102 |
$18K |
| D0274 |
Bitewings - four radiographic images |
438 |
430 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
369 |
354 |
$11K |
| D2390 |
|
34 |
16 |
$7K |
| D1110 |
Prophylaxis - adult |
106 |
106 |
$4K |
| D2331 |
|
45 |
28 |
$4K |
| D1354 |
|
37 |
12 |
$3K |
| D2330 |
|
36 |
26 |
$2K |