| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33,403 |
6,791 |
$3.95M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
10,194 |
6,960 |
$2.80M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18,891 |
5,771 |
$1.85M |
| D7140 |
Extraction, erupted tooth or exposed root |
18,491 |
5,549 |
$1.04M |
| D9222 |
|
6,952 |
6,951 |
$840K |
| D9420 |
|
9,125 |
7,862 |
$625K |
| D1510 |
|
4,012 |
2,512 |
$616K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,202 |
7,177 |
$453K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,811 |
3,075 |
$447K |
| D2330 |
|
4,823 |
2,313 |
$368K |
| D2140 |
|
5,030 |
2,299 |
$269K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,854 |
7,818 |
$188K |
| D0350 |
|
10,610 |
7,711 |
$176K |
| D9610 |
|
5,231 |
2,712 |
$130K |
| D1351 |
Sealant - per tooth |
4,245 |
1,567 |
$125K |
| D0272 |
Bitewings - two radiographic images |
7,815 |
7,788 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,550 |
878 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,158 |
624 |
$77K |
| D9221 |
|
320 |
265 |
$76K |
| D2331 |
|
852 |
561 |
$67K |
| D9220 |
|
271 |
271 |
$65K |
| D2332 |
|
449 |
269 |
$37K |
| D2160 |
|
467 |
328 |
$36K |
| D1120 |
Prophylaxis - child |
1,274 |
1,274 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
240 |
239 |
$14K |
| D1310 |
|
1,285 |
1,281 |
$13K |
| D1206 |
Topical application of fluoride varnish |
748 |
748 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
569 |
569 |
$6K |
| D0603 |
|
1,333 |
1,330 |
$4K |
| D3230 |
|
37 |
15 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$190.00 |
| D1999 |
|
92 |
92 |
$138.00 |