| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27,333 |
6,305 |
$5.39M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,900 |
4,296 |
$1.62M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
11,472 |
4,750 |
$1.48M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
15,421 |
4,766 |
$1.42M |
| D2390 |
|
6,003 |
2,125 |
$1.21M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,777 |
4,253 |
$1.17M |
| D2332 |
|
4,128 |
2,029 |
$543K |
| D1510 |
|
2,457 |
1,619 |
$495K |
| D9222 |
|
4,788 |
4,772 |
$461K |
| D9420 |
|
2,110 |
2,100 |
$359K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,654 |
1,939 |
$357K |
| D2330 |
|
3,121 |
1,741 |
$276K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,659 |
5,648 |
$209K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,338 |
844 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,323 |
5,266 |
$198K |
| D1351 |
Sealant - per tooth |
6,236 |
2,328 |
$186K |
| D1120 |
Prophylaxis - child |
5,712 |
5,699 |
$151K |
| D1206 |
Topical application of fluoride varnish |
5,946 |
5,933 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
5,260 |
5,249 |
$95K |
| D0240 |
|
6,297 |
3,269 |
$94K |
| D2331 |
|
550 |
342 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
504 |
327 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$234.18 |