| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,991 |
1,783 |
$1.32M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,595 |
1,472 |
$457K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,711 |
1,830 |
$367K |
| D2929 |
|
2,379 |
768 |
$287K |
| D9222 |
|
1,839 |
1,830 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,064 |
2,054 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,990 |
2,932 |
$61K |
| D1120 |
Prophylaxis - child |
1,809 |
1,803 |
$56K |
| D9610 |
|
1,705 |
1,699 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
625 |
286 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,404 |
3,310 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
451 |
162 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,871 |
2,787 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
926 |
925 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,092 |
1,091 |
$20K |
| D2330 |
|
251 |
133 |
$18K |
| D7960 |
|
83 |
83 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
330 |
324 |
$10K |
| D2332 |
|
88 |
42 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
220 |
218 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
93 |
$3K |
| D0240 |
|
186 |
184 |
$2K |
| D1351 |
Sealant - per tooth |
35 |
12 |
$762.18 |