| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21,391 |
3,924 |
$2.52M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
5,614 |
3,722 |
$1.25M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,348 |
2,476 |
$817K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,663 |
2,897 |
$543K |
| D9222 |
|
3,720 |
3,718 |
$450K |
| D9420 |
|
4,824 |
4,514 |
$332K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,224 |
4,209 |
$267K |
| D1510 |
|
954 |
612 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,922 |
983 |
$126K |
| D3230 |
|
1,266 |
458 |
$124K |
| D9610 |
|
3,978 |
2,207 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,723 |
4,513 |
$108K |
| D0350 |
|
7,703 |
4,445 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,742 |
878 |
$93K |
| D2332 |
|
1,004 |
529 |
$84K |
| D9220 |
|
287 |
287 |
$69K |
| D1351 |
Sealant - per tooth |
2,018 |
696 |
$63K |
| D0272 |
Bitewings - two radiographic images |
4,522 |
4,505 |
$53K |
| D9221 |
|
290 |
254 |
$50K |
| D2330 |
|
519 |
275 |
$40K |
| D1120 |
Prophylaxis - child |
1,332 |
1,331 |
$28K |
| D1310 |
|
1,024 |
1,023 |
$18K |
| D2140 |
|
258 |
154 |
$14K |
| D1206 |
Topical application of fluoride varnish |
1,176 |
1,176 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
111 |
80 |
$7K |
| D0603 |
|
1,027 |
1,026 |
$6K |
| D7111 |
|
89 |
44 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
160 |
160 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$1K |
| D2934 |
|
62 |
28 |
$0.00 |
| D1999 |
|
36 |
36 |
$0.00 |