| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,538 |
972 |
$885K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,363 |
2,280 |
$548K |
| D7240 |
Removal of impacted tooth - completely bony |
1,125 |
383 |
$219K |
| D9420 |
|
1,861 |
1,816 |
$212K |
| D2934 |
|
1,153 |
282 |
$210K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,108 |
832 |
$188K |
| D9222 |
|
2,328 |
2,299 |
$168K |
| D9612 |
|
1,636 |
1,616 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,900 |
1,853 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,145 |
2,048 |
$77K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
633 |
309 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
144 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,359 |
955 |
$38K |
| D1510 |
|
170 |
110 |
$34K |
| D1351 |
Sealant - per tooth |
1,002 |
278 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
996 |
950 |
$14K |
| D0330 |
Panoramic radiographic image |
321 |
308 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
46 |
$8K |
| D0272 |
Bitewings - two radiographic images |
637 |
617 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
12 |
$4K |
| D0603 |
|
4,267 |
3,894 |
$0.00 |