| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,770 |
1,557 |
$992K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,599 |
1,306 |
$677K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,589 |
838 |
$260K |
| D9222 |
|
1,423 |
1,297 |
$185K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,748 |
702 |
$165K |
| D1351 |
Sealant - per tooth |
5,668 |
1,199 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,754 |
1,651 |
$95K |
| D9310 |
|
1,944 |
1,898 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
220 |
$58K |
| D1120 |
Prophylaxis - child |
1,554 |
1,527 |
$55K |
| D0330 |
Panoramic radiographic image |
587 |
575 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
182 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,376 |
1,342 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,685 |
1,656 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,139 |
1,079 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,411 |
500 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
511 |
481 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
331 |
321 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
264 |
259 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$2K |
| D0190 |
|
105 |
105 |
$2K |
| D1999 |
|
128 |
123 |
$0.00 |