| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,980 |
1,730 |
$1.36M |
| D0120 |
Periodic oral evaluation - established patient |
24,610 |
24,532 |
$1.21M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,181 |
9,158 |
$565K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,668 |
2,708 |
$477K |
| D9420 |
|
4,025 |
2,383 |
$370K |
| D1120 |
Prophylaxis - child |
6,515 |
6,497 |
$276K |
| D1351 |
Sealant - per tooth |
6,911 |
2,248 |
$200K |
| D1206 |
Topical application of fluoride varnish |
6,491 |
6,463 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,146 |
6,968 |
$108K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,813 |
1,813 |
$97K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
946 |
460 |
$90K |
| D1310 |
|
2,157 |
2,145 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,299 |
433 |
$66K |
| D2330 |
|
870 |
347 |
$64K |
| D0272 |
Bitewings - two radiographic images |
5,141 |
5,104 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
891 |
398 |
$58K |
| D9920 |
|
300 |
298 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,633 |
2,546 |
$30K |
| D0603 |
|
2,479 |
2,466 |
$27K |
| D1510 |
|
228 |
153 |
$27K |
| D1354 |
|
2,621 |
564 |
$26K |
| D0274 |
Bitewings - four radiographic images |
774 |
772 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
346 |
340 |
$13K |
| D9430 |
|
258 |
257 |
$8K |
| D2390 |
|
76 |
25 |
$8K |
| D0330 |
Panoramic radiographic image |
198 |
198 |
$6K |
| D0350 |
|
395 |
180 |
$3K |
| D1352 |
|
95 |
66 |
$2K |
| D2940 |
|
36 |
12 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
216 |
214 |
$962.50 |
| D0602 |
|
75 |
75 |
$763.50 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$708.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
313 |
78 |
$0.00 |
| D9222 |
|
220 |
105 |
$0.00 |