| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,577 |
520 |
$586K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
595 |
201 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
649 |
245 |
$54K |
| D9243 |
|
663 |
271 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
490 |
449 |
$30K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
157 |
66 |
$23K |
| D1120 |
Prophylaxis - child |
754 |
710 |
$22K |
| D9239 |
|
300 |
268 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
523 |
484 |
$16K |
| D1206 |
Topical application of fluoride varnish |
707 |
669 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
478 |
454 |
$11K |
| D9222 |
|
70 |
66 |
$10K |
| D1351 |
Sealant - per tooth |
161 |
51 |
$4K |
| D0272 |
Bitewings - two radiographic images |
144 |
138 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
48 |
47 |
$2K |
| D9248 |
|
17 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
82 |
79 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$427.88 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
29 |
$348.03 |