| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,426 |
1,814 |
$1.41M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
10,163 |
1,985 |
$1.20M |
| D9420 |
|
4,153 |
2,180 |
$410K |
| D2933 |
|
1,029 |
333 |
$380K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,713 |
1,169 |
$294K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,382 |
2,592 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,147 |
2,076 |
$103K |
| D1120 |
Prophylaxis - child |
2,344 |
2,282 |
$85K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
518 |
89 |
$80K |
| D1310 |
|
2,299 |
2,168 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
2,665 |
2,563 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,342 |
2,272 |
$42K |
| D9310 |
|
622 |
616 |
$40K |
| D9993 |
|
958 |
889 |
$35K |
| D0603 |
|
2,328 |
2,224 |
$25K |
| D9430 |
|
528 |
510 |
$17K |
| D9222 |
|
88 |
88 |
$15K |
| D9610 |
|
170 |
44 |
$2K |
| D1351 |
Sealant - per tooth |
41 |
12 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
31 |
28 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$196.00 |