| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,913 |
1,700 |
$621K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,461 |
2,085 |
$441K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,082 |
644 |
$374K |
| D1120 |
Prophylaxis - child |
7,999 |
7,805 |
$247K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,570 |
2,195 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
10,219 |
9,977 |
$228K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,248 |
1,372 |
$186K |
| D1110 |
Prophylaxis - adult |
4,557 |
4,385 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,514 |
1,651 |
$139K |
| D9248 |
|
1,790 |
1,539 |
$135K |
| D9222 |
|
2,353 |
2,205 |
$134K |
| D1206 |
Topical application of fluoride varnish |
6,463 |
6,259 |
$122K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,568 |
574 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,353 |
2,245 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,855 |
3,693 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,039 |
2,764 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,849 |
3,798 |
$73K |
| D0272 |
Bitewings - two radiographic images |
4,493 |
4,394 |
$73K |
| D7240 |
Removal of impacted tooth - completely bony |
324 |
112 |
$69K |
| D2933 |
|
346 |
112 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,794 |
1,736 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
475 |
332 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,670 |
1,615 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,109 |
2,915 |
$36K |
| D7230 |
|
87 |
41 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
44 |
26 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,553 |
907 |
$14K |
| D9110 |
|
224 |
217 |
$10K |
| D2950 |
|
45 |
26 |
$4K |
| D0330 |
Panoramic radiographic image |
127 |
122 |
$4K |
| D2332 |
|
41 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
92 |
27 |
$3K |
| D0460 |
|
58 |
38 |
$1K |
| D9610 |
|
753 |
709 |
$878.13 |