| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14,252 |
4,669 |
$1.98M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
26,846 |
4,384 |
$1.87M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,269 |
7,107 |
$1.82M |
| D1120 |
Prophylaxis - child |
50,688 |
49,210 |
$1.39M |
| D0120 |
Periodic oral evaluation - established patient |
45,460 |
44,297 |
$1.19M |
| D1208 |
Topical application of fluoride, excluding varnish |
50,101 |
48,666 |
$839K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,704 |
4,922 |
$740K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,174 |
4,215 |
$564K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,376 |
2,824 |
$504K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,248 |
13,149 |
$453K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,043 |
9,592 |
$442K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,042 |
8,886 |
$438K |
| D0272 |
Bitewings - two radiographic images |
19,431 |
18,874 |
$358K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,428 |
1,587 |
$306K |
| D1510 |
|
1,528 |
994 |
$282K |
| D2332 |
|
2,767 |
1,364 |
$267K |
| D0220 |
Intraoral - periapical first radiographic image |
17,618 |
16,957 |
$265K |
| D9612 |
|
4,558 |
4,349 |
$263K |
| D0240 |
|
15,320 |
9,107 |
$245K |
| D9222 |
|
3,033 |
2,897 |
$218K |
| D0330 |
Panoramic radiographic image |
3,493 |
3,406 |
$202K |
| D1351 |
Sealant - per tooth |
7,160 |
2,708 |
$197K |
| D1110 |
Prophylaxis - adult |
4,192 |
4,084 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
3,134 |
3,012 |
$117K |
| D2330 |
|
1,765 |
976 |
$116K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,846 |
2,949 |
$109K |
| D1206 |
Topical application of fluoride varnish |
3,298 |
3,208 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,384 |
1,347 |
$45K |
| D2335 |
|
106 |
64 |
$13K |
| D1354 |
|
264 |
109 |
$2K |
| D1999 |
|
542 |
462 |
$0.00 |
| D3120 |
|
1,077 |
686 |
$0.00 |