| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25,307 |
3,191 |
$3.03M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
8,231 |
3,046 |
$2.06M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
11,080 |
2,733 |
$1.10M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,103 |
2,398 |
$464K |
| D1510 |
|
2,234 |
1,384 |
$392K |
| D9222 |
|
3,039 |
3,038 |
$372K |
| D9610 |
|
5,105 |
3,476 |
$293K |
| D9221 |
|
730 |
484 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,347 |
3,322 |
$221K |
| D9430 |
|
5,009 |
4,986 |
$160K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,009 |
3,432 |
$124K |
| D1120 |
Prophylaxis - child |
3,438 |
3,409 |
$124K |
| D9220 |
|
479 |
479 |
$115K |
| D2330 |
|
1,219 |
658 |
$93K |
| D0350 |
|
10,295 |
3,126 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,067 |
459 |
$72K |
| D1351 |
Sealant - per tooth |
1,949 |
752 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,160 |
2,145 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,379 |
3,354 |
$40K |
| D2331 |
|
408 |
231 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,147 |
1,135 |
$12K |
| D2140 |
|
148 |
90 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
80 |
$6K |
| D0603 |
|
24 |
24 |
$0.00 |