| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
3,673 |
3,656 |
$3.30M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
523 |
394 |
$328K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
413 |
280 |
$115K |
| D2929 |
|
170 |
128 |
$72K |
| 70310 |
|
2,503 |
2,489 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
166 |
$44K |
| D9222 |
|
340 |
309 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
193 |
151 |
$29K |
| D7999 |
|
27 |
27 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
400 |
369 |
$16K |
| D2390 |
|
13 |
13 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
386 |
338 |
$7K |
| D0272 |
Bitewings - two radiographic images |
297 |
277 |
$7K |
| D2934 |
|
14 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
411 |
379 |
$6K |
| D1510 |
|
26 |
13 |
$5K |
| D1120 |
Prophylaxis - child |
183 |
166 |
$5K |
| D0240 |
|
153 |
135 |
$3K |
| D2330 |
|
16 |
12 |
$2K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
16 |
16 |
$2K |
| D1206 |
Topical application of fluoride varnish |
67 |
63 |
$1K |
| D1351 |
Sealant - per tooth |
40 |
25 |
$1K |