| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
56,451 |
12,067 |
$6.63M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
10,997 |
10,784 |
$4.43M |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
9,523 |
9,490 |
$3.57M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
32,848 |
9,566 |
$3.23M |
| D7140 |
Extraction, erupted tooth or exposed root |
34,958 |
9,332 |
$1.97M |
| D9420 |
|
17,586 |
16,671 |
$1.65M |
| D9610 |
|
16,427 |
16,260 |
$1.36M |
| D9222 |
|
10,800 |
10,794 |
$1.32M |
| D9221 |
|
5,356 |
5,127 |
$1.27M |
| D9220 |
|
5,301 |
5,292 |
$1.13M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15,261 |
6,443 |
$1.01M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,500 |
12,476 |
$787K |
| D2330 |
|
9,213 |
4,704 |
$705K |
| D0350 |
|
22,166 |
13,912 |
$504K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,146 |
17,019 |
$494K |
| D1510 |
|
3,279 |
2,166 |
$475K |
| D2140 |
|
7,455 |
4,257 |
$403K |
| 0360 |
|
3,415 |
2,859 |
$348K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
5,121 |
4,900 |
$284K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,646 |
1,056 |
$267K |
| D1351 |
Sealant - per tooth |
8,067 |
3,191 |
$237K |
| D0272 |
Bitewings - two radiographic images |
15,447 |
15,401 |
$179K |
| D1120 |
Prophylaxis - child |
4,806 |
4,801 |
$165K |
| D1310 |
|
2,630 |
2,622 |
$95K |
| D1206 |
Topical application of fluoride varnish |
4,765 |
4,760 |
$83K |
| 0160 |
|
2,207 |
2,194 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
1,344 |
1,343 |
$60K |
| 0760 |
|
2,645 |
2,501 |
$57K |
| 0710 |
|
2,998 |
2,803 |
$51K |
| A4649 |
Surgical supply; miscellaneous |
2,128 |
2,118 |
$45K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
5,152 |
4,862 |
$40K |
| D2331 |
|
501 |
297 |
$40K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,056 |
1,056 |
$35K |
| D9430 |
|
637 |
635 |
$17K |
| J2704 |
Injection, propofol, 10 mg |
2,882 |
2,754 |
$16K |
| 0490 |
|
372 |
271 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
228 |
228 |
$12K |
| D0603 |
|
2,497 |
2,489 |
$11K |
| 99199 |
Unlisted special service, procedure or report |
102 |
24 |
$5K |
| D2160 |
|
57 |
43 |
$4K |
| 0761 |
|
163 |
163 |
$4K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
632 |
627 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
171 |
$2K |
| Z7506 |
|
15 |
15 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
169 |
$1K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
164 |
164 |
$810.57 |
| J3490 |
Unclassified drugs |
64 |
57 |
$599.75 |
| Z7514 |
|
15 |
15 |
$556.95 |
| G0378 |
Hospital observation service, per hour |
19 |
12 |
$451.63 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$345.60 |
| Z7500 |
|
15 |
15 |
$324.90 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
70 |
52 |
$318.99 |
| J2175 |
Injection, meperidine hydrochloride, per 100 mg |
39 |
33 |
$309.65 |
| J7642 |
Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram |
21 |
12 |
$281.04 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
54 |
47 |
$275.49 |
| Z7512 |
|
15 |
15 |
$248.85 |
| D9993 |
|
2,400 |
2,392 |
$0.00 |