| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,887 |
668 |
$451K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
605 |
367 |
$243K |
| D2933 |
|
626 |
208 |
$107K |
| D1120 |
Prophylaxis - child |
2,871 |
2,860 |
$85K |
| D9222 |
|
368 |
367 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,284 |
1,598 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,831 |
2,821 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,908 |
1,901 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
850 |
423 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
417 |
312 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
318 |
249 |
$32K |
| D1351 |
Sealant - per tooth |
1,186 |
414 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
671 |
668 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,882 |
1,863 |
$26K |
| D0330 |
Panoramic radiographic image |
419 |
417 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
649 |
632 |
$23K |
| D0272 |
Bitewings - two radiographic images |
839 |
839 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
528 |
527 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
479 |
477 |
$12K |
| D0274 |
Bitewings - four radiographic images |
372 |
371 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
64 |
44 |
$6K |
| D1510 |
|
32 |
25 |
$5K |
| D1354 |
|
98 |
38 |
$530.00 |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$285.00 |
| D1999 |
|
14 |
14 |
$0.00 |