| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,870 |
4,239 |
$3.87M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,197 |
3,220 |
$1.31M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,235 |
4,589 |
$1.23M |
| D9222 |
|
4,810 |
4,668 |
$420K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,525 |
5,413 |
$308K |
| D2335 |
|
1,272 |
441 |
$208K |
| D2934 |
|
1,110 |
364 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,291 |
667 |
$128K |
| D0240 |
|
5,547 |
4,772 |
$123K |
| D0272 |
Bitewings - two radiographic images |
4,966 |
4,874 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,590 |
3,972 |
$92K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
754 |
438 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,403 |
4,319 |
$51K |
| D2330 |
|
564 |
329 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
369 |
173 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,777 |
1,747 |
$44K |
| D0350 |
|
610 |
600 |
$32K |
| D3120 |
|
789 |
399 |
$26K |
| D1120 |
Prophylaxis - child |
516 |
508 |
$21K |
| D1351 |
Sealant - per tooth |
411 |
140 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
33 |
12 |
$10K |
| D9420 |
|
408 |
400 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
175 |
164 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
14 |
$3K |
| D1330 |
|
434 |
434 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
68 |
68 |
$996.15 |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
21 |
$455.00 |