| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21,089 |
3,105 |
$3.02M |
| D7140 |
Extraction, erupted tooth or exposed root |
4,352 |
1,573 |
$262K |
| D0210 |
Intraoral - complete series of radiographic images |
4,101 |
4,069 |
$247K |
| D2934 |
|
1,444 |
481 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,355 |
4,332 |
$138K |
| D7240 |
Removal of impacted tooth - completely bony |
354 |
120 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
812 |
386 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,670 |
2,650 |
$47K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
802 |
352 |
$42K |
| D1351 |
Sealant - per tooth |
1,454 |
359 |
$35K |
| D2931 |
|
234 |
89 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
381 |
229 |
$31K |
| D0350 |
|
2,214 |
2,202 |
$25K |
| D1330 |
|
2,212 |
2,198 |
$24K |
| D9222 |
|
371 |
358 |
$21K |
| D0330 |
Panoramic radiographic image |
314 |
311 |
$19K |
| D4341 |
|
113 |
27 |
$6K |
| D7111 |
|
467 |
218 |
$5K |
| D0160 |
|
334 |
331 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$2K |
| D9310 |
|
114 |
111 |
$2K |
| D2330 |
|
21 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
26 |
$675.54 |
| D9612 |
|
18 |
18 |
$609.11 |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
57 |
$551.38 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$432.75 |
| D0240 |
|
27 |
12 |
$78.40 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$46.76 |
| D0603 |
|
8,031 |
7,083 |
$33.16 |
| D1999 |
|
110 |
105 |
$0.00 |