| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,887 |
2,294 |
$1.73M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
11,087 |
2,315 |
$1.08M |
| D7140 |
Extraction, erupted tooth or exposed root |
7,683 |
2,000 |
$644K |
| D9222 |
|
2,849 |
2,315 |
$512K |
| D2934 |
|
747 |
248 |
$203K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,707 |
708 |
$172K |
| D0140 |
Limited oral evaluation - problem focused |
4,761 |
4,386 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,089 |
2,831 |
$113K |
| D9612 |
|
1,980 |
1,613 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,035 |
512 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
644 |
295 |
$51K |
| D1351 |
Sealant - per tooth |
1,431 |
477 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,924 |
2,592 |
$46K |
| D0240 |
|
2,735 |
2,461 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,783 |
2,571 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,875 |
2,630 |
$20K |
| D2330 |
|
242 |
147 |
$17K |
| D0350 |
|
412 |
383 |
$7K |
| D2931 |
|
23 |
13 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
35 |
$5K |
| D0330 |
Panoramic radiographic image |
59 |
55 |
$5K |
| D0603 |
|
3,113 |
2,530 |
$0.04 |
| D9420 |
|
944 |
792 |
$0.00 |
| D1330 |
|
890 |
740 |
$0.00 |
| D3120 |
|
102 |
45 |
$0.00 |
| D9310 |
|
72 |
59 |
$0.00 |
| D1310 |
|
83 |
61 |
$0.00 |