| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16,997 |
4,193 |
$1.98M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
30,450 |
5,301 |
$1.68M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,839 |
6,654 |
$785K |
| D1120 |
Prophylaxis - child |
27,767 |
27,555 |
$759K |
| D1206 |
Topical application of fluoride varnish |
37,214 |
36,913 |
$643K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,693 |
4,344 |
$631K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,195 |
4,877 |
$605K |
| D0120 |
Periodic oral evaluation - established patient |
31,183 |
30,908 |
$515K |
| D1110 |
Prophylaxis - adult |
10,272 |
10,165 |
$420K |
| D1351 |
Sealant - per tooth |
14,604 |
4,944 |
$395K |
| D9310 |
|
5,524 |
5,469 |
$382K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,637 |
11,179 |
$330K |
| D9222 |
|
5,304 |
5,233 |
$283K |
| D0272 |
Bitewings - two radiographic images |
14,141 |
14,003 |
$237K |
| D9612 |
|
5,432 |
5,381 |
$185K |
| D3120 |
|
11,100 |
5,105 |
$178K |
| D0274 |
Bitewings - four radiographic images |
7,282 |
7,198 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
7,468 |
5,186 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,139 |
5,010 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,502 |
4,860 |
$118K |
| D9630 |
|
6,609 |
6,536 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
8,778 |
8,593 |
$81K |
| D0240 |
|
5,462 |
3,923 |
$54K |
| D7240 |
Removal of impacted tooth - completely bony |
177 |
51 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,681 |
1,650 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
350 |
174 |
$30K |
| D0330 |
Panoramic radiographic image |
322 |
310 |
$14K |
| D2330 |
|
157 |
88 |
$14K |
| D2332 |
|
123 |
61 |
$13K |
| D2934 |
|
56 |
26 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
149 |
149 |
$3K |
| D1510 |
|
13 |
12 |
$2K |
| D7111 |
|
43 |
26 |
$1K |
| D9920 |
|
13 |
13 |
$890.50 |
| D9995 |
|
21 |
21 |
$735.00 |
| D9996 |
|
46 |
42 |
$675.00 |
| D9994 |
|
67 |
63 |
$546.48 |
| D9219 |
|
155 |
155 |
$0.00 |