| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,845 |
921 |
$434K |
| D1120 |
Prophylaxis - child |
4,582 |
4,451 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,443 |
670 |
$126K |
| D1206 |
Topical application of fluoride varnish |
5,887 |
5,682 |
$101K |
| D1351 |
Sealant - per tooth |
3,503 |
974 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,190 |
2,112 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,018 |
511 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,734 |
2,685 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,551 |
3,422 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,472 |
1,284 |
$41K |
| D0330 |
Panoramic radiographic image |
693 |
667 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,932 |
2,808 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
170 |
$22K |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
386 |
129 |
$21K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
685 |
277 |
$16K |
| D1354 |
|
634 |
157 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,345 |
935 |
$11K |
| D9420 |
|
152 |
132 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
254 |
250 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
137 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
12 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
59 |
13 |
$3K |
| D1510 |
|
19 |
13 |
$3K |
| D9222 |
|
13 |
13 |
$1K |
| 97161 |
|
17 |
14 |
$685.22 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$284.47 |
| D9219 |
|
13 |
13 |
$210.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
82 |
75 |
$174.50 |
| 98940 |
|
322 |
186 |
$174.13 |
| D0603 |
|
400 |
397 |
$0.00 |
| D0191 |
|
14 |
14 |
$0.00 |