| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25,109 |
3,460 |
$3.72M |
| D9243 |
|
7,525 |
2,823 |
$570K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,754 |
1,927 |
$478K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,927 |
1,869 |
$463K |
| D2934 |
|
1,340 |
420 |
$277K |
| D9239 |
|
3,311 |
2,808 |
$252K |
| D1510 |
|
909 |
536 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
1,390 |
1,266 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,771 |
1,607 |
$73K |
| D1120 |
Prophylaxis - child |
1,796 |
1,666 |
$67K |
| D1351 |
Sealant - per tooth |
2,135 |
663 |
$65K |
| D9420 |
|
304 |
251 |
$37K |
| D9248 |
|
273 |
228 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,595 |
1,493 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
916 |
851 |
$27K |
| D2330 |
|
285 |
168 |
$27K |
| D7111 |
|
372 |
165 |
$25K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
831 |
200 |
$21K |
| D0272 |
Bitewings - two radiographic images |
601 |
552 |
$17K |
| D9222 |
|
271 |
198 |
$10K |
| D0330 |
Panoramic radiographic image |
107 |
102 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
146 |
134 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
74 |
$3K |
| D0274 |
Bitewings - four radiographic images |
31 |
30 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
95 |
76 |
$1K |