| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,707 |
2,002 |
$1.23M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,433 |
1,481 |
$1.15M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,169 |
629 |
$504K |
| D2954 |
|
3,842 |
2,338 |
$399K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,712 |
333 |
$200K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,781 |
351 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,352 |
1,123 |
$155K |
| D2931 |
|
1,205 |
809 |
$149K |
| D3320 |
|
362 |
277 |
$131K |
| D3310 |
|
360 |
141 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,586 |
2,321 |
$101K |
| D9222 |
|
633 |
629 |
$77K |
| D9430 |
|
1,932 |
1,839 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,068 |
540 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
709 |
421 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
720 |
717 |
$54K |
| D9610 |
|
794 |
628 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
488 |
480 |
$32K |
| D1120 |
Prophylaxis - child |
536 |
536 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,780 |
1,936 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
373 |
135 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
306 |
95 |
$19K |
| D2330 |
|
257 |
121 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
377 |
377 |
$18K |
| D0274 |
Bitewings - four radiographic images |
544 |
542 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
913 |
880 |
$11K |
| D0350 |
|
738 |
247 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
449 |
449 |
$6K |
| D3348 |
|
13 |
12 |
$6K |
| D2140 |
|
82 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
313 |
310 |
$4K |
| D4341 |
|
38 |
13 |
$3K |
| D1510 |
|
15 |
12 |
$3K |
| D2332 |
|
24 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$420.00 |
| D0270 |
|
44 |
41 |
$215.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$210.00 |