| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,657 |
3,846 |
$1.62M |
| D1120 |
Prophylaxis - child |
32,658 |
32,431 |
$1.61M |
| D0120 |
Periodic oral evaluation - established patient |
21,096 |
20,956 |
$1.45M |
| D1310 |
|
16,693 |
16,534 |
$745K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
7,267 |
2,814 |
$716K |
| D1208 |
Topical application of fluoride, excluding varnish |
31,771 |
31,557 |
$647K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,362 |
1,675 |
$622K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,742 |
8,678 |
$590K |
| D0350 |
|
69,618 |
25,735 |
$535K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,044 |
5,585 |
$533K |
| D0230 |
Intraoral - periapical each additional radiographic image |
112,754 |
28,596 |
$470K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,153 |
4,071 |
$462K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,020 |
8,766 |
$359K |
| D1351 |
Sealant - per tooth |
9,875 |
3,060 |
$348K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,459 |
3,851 |
$293K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,038 |
4,025 |
$282K |
| D9222 |
|
1,687 |
1,682 |
$206K |
| D0603 |
|
13,111 |
13,002 |
$193K |
| D0220 |
Intraoral - periapical first radiographic image |
15,528 |
15,203 |
$184K |
| D1510 |
|
800 |
561 |
$163K |
| D0274 |
Bitewings - four radiographic images |
7,417 |
7,371 |
$158K |
| D3230 |
|
1,559 |
546 |
$153K |
| D0272 |
Bitewings - two radiographic images |
8,481 |
8,449 |
$100K |
| D0330 |
Panoramic radiographic image |
2,598 |
2,581 |
$75K |
| D2330 |
|
947 |
527 |
$74K |
| D9430 |
|
2,012 |
1,970 |
$64K |
| D0602 |
|
2,778 |
2,770 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
345 |
295 |
$28K |
| D0601 |
|
228 |
227 |
$3K |
| D2331 |
|
21 |
13 |
$2K |
| D0270 |
|
32 |
32 |
$160.00 |
| D9996 |
|
44 |
44 |
$0.00 |