| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,959 |
863 |
$561K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,556 |
3,548 |
$492K |
| D1351 |
Sealant - per tooth |
11,105 |
3,106 |
$294K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,743 |
1,623 |
$258K |
| D1120 |
Prophylaxis - child |
6,616 |
6,593 |
$235K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,881 |
6,640 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,467 |
1,547 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
6,367 |
6,347 |
$181K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,620 |
4,450 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,948 |
7,920 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,593 |
1,585 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
7,050 |
6,966 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,954 |
1,941 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,714 |
2,706 |
$62K |
| D1110 |
Prophylaxis - adult |
1,168 |
1,164 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
492 |
270 |
$40K |
| D0274 |
Bitewings - four radiographic images |
969 |
966 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
496 |
301 |
$27K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
109 |
24 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
281 |
$5K |
| D2330 |
|
48 |
29 |
$3K |
| D2332 |
|
21 |
12 |
$3K |
| D9310 |
|
248 |
247 |
$3K |
| D9222 |
|
24 |
24 |
$2K |
| D9248 |
|
13 |
13 |
$1K |
| D0603 |
|
12,220 |
12,181 |
$0.00 |