| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,260 |
1,708 |
$615K |
| D1120 |
Prophylaxis - child |
7,148 |
7,142 |
$293K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,031 |
6,452 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,474 |
1,430 |
$213K |
| D1206 |
Topical application of fluoride varnish |
7,150 |
7,146 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
5,759 |
5,757 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,441 |
1,032 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,797 |
1,205 |
$167K |
| D1351 |
Sealant - per tooth |
4,447 |
1,404 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
7,576 |
7,503 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
2,180 |
2,143 |
$131K |
| D9920 |
|
2,114 |
2,034 |
$110K |
| D0240 |
|
4,373 |
2,519 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
876 |
875 |
$52K |
| D1354 |
|
1,751 |
907 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
535 |
533 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
259 |
200 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,055 |
1,055 |
$26K |
| D2332 |
|
70 |
54 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
186 |
186 |
$8K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
91 |
13 |
$6K |
| D1510 |
|
27 |
26 |
$5K |
| D2330 |
|
42 |
30 |
$4K |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$3K |
| D9222 |
|
13 |
13 |
$1K |
| D9310 |
|
13 |
13 |
$979.20 |
| D9248 |
|
12 |
12 |
$593.62 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,122 |
2,983 |
$25.00 |
| D1999 |
|
804 |
775 |
$0.00 |