| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
156,984 |
27,526 |
$19.17M |
| D7140 |
Extraction, erupted tooth or exposed root |
78,268 |
23,083 |
$3.51M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31,462 |
30,902 |
$1.30M |
| D0210 |
Intraoral - complete series of radiographic images |
32,408 |
31,774 |
$1.19M |
| D9420 |
|
33,266 |
32,578 |
$870K |
| D0603 |
|
53,461 |
51,946 |
$493K |
| D2934 |
|
11,481 |
3,572 |
$461K |
| D0140 |
Limited oral evaluation - problem focused |
37,708 |
36,413 |
$429K |
| D2330 |
|
11,245 |
6,020 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,516 |
5,290 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,295 |
8,284 |
$103K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13,291 |
6,826 |
$99K |
| D1351 |
Sealant - per tooth |
62,624 |
17,049 |
$82K |
| D0350 |
|
24,640 |
24,236 |
$66K |
| D2332 |
|
1,841 |
1,074 |
$58K |
| D7111 |
|
4,637 |
2,313 |
$49K |
| D1330 |
|
31,709 |
31,128 |
$38K |
| D3120 |
|
14,954 |
6,425 |
$31K |
| D9971 |
|
1,004 |
578 |
$9K |
| D9310 |
|
472 |
465 |
$4K |
| D2331 |
|
668 |
427 |
$4K |
| D4355 |
|
85 |
82 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
34 |
20 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
50 |
$2K |
| D9222 |
|
34 |
20 |
$549.00 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$257.25 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$67.00 |
| D1999 |
|
798 |
796 |
$0.00 |
| D2954 |
|
22 |
12 |
$0.00 |
| D2932 |
|
55 |
13 |
$0.00 |
| D2950 |
|
195 |
130 |
$0.00 |
| D9612 |
|
33 |
20 |
$0.00 |
| D2931 |
|
24 |
12 |
$0.00 |