| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,506 |
2,044 |
$1.13M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,241 |
1,827 |
$714K |
| D1120 |
Prophylaxis - child |
8,447 |
8,387 |
$384K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,669 |
1,819 |
$310K |
| D1310 |
|
5,817 |
5,771 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,456 |
3,445 |
$232K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,962 |
1,705 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
2,843 |
2,823 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,430 |
8,369 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,925 |
6,956 |
$150K |
| D1351 |
Sealant - per tooth |
3,973 |
1,305 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,249 |
3,197 |
$128K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
501 |
109 |
$118K |
| D2330 |
|
1,186 |
643 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,668 |
965 |
$90K |
| D0603 |
|
5,794 |
5,748 |
$85K |
| D9993 |
|
1,523 |
1,515 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
949 |
595 |
$75K |
| D9430 |
|
1,791 |
1,690 |
$57K |
| D0272 |
Bitewings - two radiographic images |
4,701 |
4,669 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
884 |
878 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,466 |
2,425 |
$29K |
| D2331 |
|
186 |
118 |
$15K |
| D9222 |
|
109 |
109 |
$13K |
| D0350 |
|
1,367 |
408 |
$11K |
| D9610 |
|
333 |
122 |
$10K |
| D1510 |
|
50 |
39 |
$9K |
| D2332 |
|
17 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$1K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$870.00 |
| D0274 |
Bitewings - four radiographic images |
36 |
36 |
$777.60 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D0270 |
|
32 |
32 |
$160.00 |