| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23,180 |
4,468 |
$2.79M |
| D1351 |
Sealant - per tooth |
43,040 |
6,939 |
$901K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,429 |
2,957 |
$797K |
| D1120 |
Prophylaxis - child |
20,497 |
19,949 |
$726K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,745 |
2,669 |
$521K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,459 |
1,107 |
$515K |
| D1206 |
Topical application of fluoride varnish |
22,930 |
22,343 |
$368K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,819 |
6,594 |
$365K |
| D2929 |
|
995 |
264 |
$278K |
| D0272 |
Bitewings - two radiographic images |
9,915 |
9,650 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
6,686 |
6,532 |
$190K |
| D0330 |
Panoramic radiographic image |
3,187 |
3,109 |
$186K |
| D9222 |
|
1,177 |
1,107 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,482 |
646 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,785 |
883 |
$132K |
| D9248 |
|
1,564 |
1,376 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,171 |
4,814 |
$122K |
| D9310 |
|
2,365 |
2,281 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
8,156 |
7,557 |
$102K |
| D2940 |
|
1,603 |
620 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
3,421 |
3,312 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,073 |
2,910 |
$64K |
| D2390 |
|
148 |
38 |
$44K |
| D1110 |
Prophylaxis - adult |
504 |
489 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
728 |
721 |
$14K |
| D0190 |
|
569 |
562 |
$8K |
| D7111 |
|
110 |
41 |
$7K |
| D1510 |
|
34 |
24 |
$6K |
| D1330 |
|
13 |
13 |
$319.28 |
| D1999 |
|
1,366 |
1,299 |
$0.00 |