| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
59,048 |
10,533 |
$8.30M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16,723 |
6,167 |
$1.33M |
| D2934 |
|
7,692 |
2,549 |
$1.09M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,587 |
5,617 |
$864K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,282 |
3,879 |
$667K |
| D0210 |
Intraoral - complete series of radiographic images |
8,625 |
8,506 |
$539K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,310 |
13,871 |
$456K |
| D1351 |
Sealant - per tooth |
18,160 |
5,223 |
$429K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,014 |
10,216 |
$291K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
7,301 |
3,436 |
$287K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,947 |
1,473 |
$277K |
| D9222 |
|
3,682 |
3,549 |
$196K |
| D0140 |
Limited oral evaluation - problem focused |
10,645 |
10,524 |
$178K |
| D2330 |
|
1,492 |
866 |
$106K |
| D1330 |
|
8,683 |
8,512 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
11,737 |
10,593 |
$92K |
| D0350 |
|
6,126 |
6,017 |
$66K |
| D0272 |
Bitewings - two radiographic images |
5,470 |
5,129 |
$65K |
| D9612 |
|
1,755 |
1,650 |
$52K |
| D7240 |
Removal of impacted tooth - completely bony |
178 |
65 |
$47K |
| D0330 |
Panoramic radiographic image |
788 |
773 |
$43K |
| D1510 |
|
223 |
159 |
$32K |
| D9310 |
|
606 |
590 |
$8K |
| D0160 |
|
499 |
496 |
$7K |
| D0367 |
|
98 |
92 |
$7K |
| D7111 |
|
291 |
152 |
$3K |
| D0274 |
Bitewings - four radiographic images |
103 |
94 |
$2K |
| D9248 |
|
14 |
14 |
$487.52 |
| D0273 |
|
25 |
25 |
$435.15 |
| D0240 |
|
18 |
16 |
$147.00 |
| D3120 |
|
45 |
18 |
$57.34 |
| D0603 |
|
27,481 |
25,172 |
$0.10 |
| D1999 |
|
139 |
137 |
$0.00 |