| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54,155 |
10,776 |
$6.27M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
37,648 |
9,520 |
$3.64M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
10,467 |
7,292 |
$3.41M |
| D9420 |
|
13,622 |
12,562 |
$1.32M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,973 |
7,467 |
$1.28M |
| D9222 |
|
7,326 |
7,290 |
$892K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13,488 |
5,014 |
$885K |
| D9610 |
|
10,018 |
9,156 |
$739K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,076 |
10,908 |
$698K |
| D1510 |
|
4,298 |
2,870 |
$675K |
| D2330 |
|
8,272 |
3,979 |
$618K |
| D9221 |
|
2,338 |
2,020 |
$563K |
| D9220 |
|
2,061 |
2,057 |
$445K |
| D0230 |
Intraoral - periapical each additional radiographic image |
57,014 |
10,962 |
$393K |
| D2140 |
|
7,423 |
3,610 |
$391K |
| D1120 |
Prophylaxis - child |
13,065 |
12,837 |
$229K |
| D1351 |
Sealant - per tooth |
5,225 |
1,817 |
$155K |
| D0272 |
Bitewings - two radiographic images |
10,827 |
10,738 |
$127K |
| D1206 |
Topical application of fluoride varnish |
13,050 |
12,831 |
$127K |
| D2331 |
|
1,541 |
851 |
$123K |
| D0350 |
|
9,608 |
6,766 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,009 |
1,883 |
$84K |
| D0145 |
Oral evaluation for a patient under three years of age |
252 |
228 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
38 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
40 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
36 |
36 |
$1K |
| D2934 |
|
114 |
42 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |