| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,272 |
1,300 |
$705K |
| D1120 |
Prophylaxis - child |
6,948 |
6,422 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,194 |
925 |
$191K |
| D1206 |
Topical application of fluoride varnish |
8,180 |
7,585 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
5,592 |
5,360 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,479 |
2,059 |
$102K |
| D0272 |
Bitewings - two radiographic images |
4,266 |
4,066 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,978 |
1,864 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
939 |
519 |
$95K |
| D9243 |
|
331 |
89 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,633 |
1,466 |
$61K |
| D0240 |
|
4,042 |
1,897 |
$57K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
318 |
46 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,479 |
2,279 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
285 |
162 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
236 |
$31K |
| D9420 |
|
102 |
100 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,090 |
811 |
$22K |
| D9239 |
|
101 |
87 |
$21K |
| D0330 |
Panoramic radiographic image |
302 |
287 |
$19K |
| D9222 |
|
54 |
46 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
87 |
84 |
$8K |
| D2390 |
|
27 |
12 |
$6K |
| D9612 |
|
53 |
46 |
$5K |
| D1351 |
Sealant - per tooth |
50 |
27 |
$2K |
| D0270 |
|
28 |
26 |
$519.56 |
| D1354 |
|
39 |
13 |
$344.72 |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$0.00 |