| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,981 |
2,323 |
$1.06M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,709 |
2,084 |
$757K |
| D0120 |
Periodic oral evaluation - established patient |
10,014 |
9,962 |
$565K |
| D1120 |
Prophylaxis - child |
13,185 |
13,115 |
$525K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,024 |
2,619 |
$400K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,959 |
3,947 |
$254K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,713 |
12,909 |
$228K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
712 |
247 |
$216K |
| D1310 |
|
4,695 |
4,673 |
$214K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,028 |
12,963 |
$197K |
| D1351 |
Sealant - per tooth |
6,065 |
2,321 |
$177K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,645 |
1,116 |
$176K |
| D9993 |
|
2,128 |
2,125 |
$136K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,228 |
3,161 |
$126K |
| D1510 |
|
705 |
472 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,453 |
740 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
5,471 |
5,400 |
$64K |
| D7240 |
Removal of impacted tooth - completely bony |
268 |
93 |
$61K |
| D0274 |
Bitewings - four radiographic images |
3,004 |
2,986 |
$61K |
| D0272 |
Bitewings - two radiographic images |
3,986 |
3,961 |
$47K |
| D0603 |
|
3,091 |
3,085 |
$46K |
| D2330 |
|
578 |
334 |
$44K |
| D0330 |
Panoramic radiographic image |
1,211 |
1,207 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
621 |
340 |
$33K |
| D9222 |
|
244 |
244 |
$30K |
| D2335 |
|
250 |
125 |
$29K |
| D9248 |
|
829 |
822 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
92 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
334 |
334 |
$21K |
| D9610 |
|
460 |
247 |
$21K |
| D2140 |
|
372 |
185 |
$20K |
| D2160 |
|
242 |
131 |
$19K |
| D0601 |
|
530 |
522 |
$8K |
| D9430 |
|
227 |
218 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D1206 |
Topical application of fluoride varnish |
87 |
86 |
$1K |
| D0602 |
|
55 |
55 |
$825.00 |
| D9920 |
|
82 |
81 |
$420.00 |
| D0350 |
|
46 |
27 |
$326.40 |