| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,913 |
1,537 |
$439K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
869 |
352 |
$402K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,855 |
2,303 |
$380K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,085 |
1,276 |
$294K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,547 |
1,780 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
6,567 |
6,562 |
$264K |
| D1120 |
Prophylaxis - child |
8,813 |
8,793 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,881 |
2,003 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50,370 |
10,378 |
$203K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,884 |
2,879 |
$169K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,080 |
3,847 |
$155K |
| D2330 |
|
1,911 |
607 |
$139K |
| D9993 |
|
1,925 |
1,925 |
$111K |
| D2932 |
|
1,005 |
391 |
$101K |
| D1351 |
Sealant - per tooth |
4,798 |
1,317 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,748 |
8,730 |
$97K |
| D1310 |
|
1,926 |
1,926 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,607 |
6,376 |
$74K |
| D0272 |
Bitewings - two radiographic images |
5,620 |
5,606 |
$65K |
| D1510 |
|
462 |
376 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
866 |
865 |
$45K |
| D9222 |
|
351 |
351 |
$43K |
| D9430 |
|
966 |
945 |
$30K |
| D9610 |
|
430 |
328 |
$27K |
| D0350 |
|
4,157 |
2,290 |
$26K |
| D0603 |
|
1,241 |
1,241 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
142 |
$16K |
| D0601 |
|
645 |
644 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
16 |
$910.88 |