| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25,822 |
5,773 |
$3.04M |
| D0120 |
Periodic oral evaluation - established patient |
37,229 |
37,138 |
$1.98M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13,827 |
3,654 |
$1.37M |
| D1120 |
Prophylaxis - child |
36,060 |
35,953 |
$1.32M |
| D2140 |
|
18,564 |
9,736 |
$1.01M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,994 |
1,494 |
$988K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14,373 |
8,301 |
$960K |
| D0230 |
Intraoral - periapical each additional radiographic image |
200,329 |
52,026 |
$836K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,830 |
5,427 |
$561K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,507 |
8,483 |
$515K |
| D0274 |
Bitewings - four radiographic images |
23,201 |
23,130 |
$491K |
| D1208 |
Topical application of fluoride, excluding varnish |
38,935 |
38,823 |
$444K |
| D1351 |
Sealant - per tooth |
14,515 |
6,144 |
$385K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,396 |
8,157 |
$332K |
| D0350 |
|
29,520 |
15,134 |
$329K |
| D1110 |
Prophylaxis - adult |
3,238 |
3,228 |
$260K |
| D9222 |
|
1,456 |
1,456 |
$178K |
| D0272 |
Bitewings - two radiographic images |
15,128 |
15,090 |
$175K |
| D0220 |
Intraoral - periapical first radiographic image |
14,654 |
14,544 |
$173K |
| D0210 |
Intraoral - complete series of radiographic images |
3,113 |
3,098 |
$140K |
| D1310 |
|
2,596 |
2,585 |
$105K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,701 |
1,701 |
$97K |
| D2160 |
|
1,063 |
703 |
$84K |
| D9430 |
|
2,219 |
2,206 |
$69K |
| D9248 |
|
1,991 |
1,985 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
588 |
332 |
$68K |
| D1510 |
|
485 |
371 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,102 |
647 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,036 |
2,035 |
$45K |
| D4341 |
|
601 |
207 |
$42K |
| D2330 |
|
539 |
290 |
$41K |
| D9920 |
|
276 |
263 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
460 |
350 |
$31K |
| D0601 |
|
1,750 |
1,739 |
$24K |
| D9610 |
|
794 |
260 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
27 |
24 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
94 |
52 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
17 |
$7K |
| D0603 |
|
518 |
518 |
$5K |
| D0270 |
|
224 |
224 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$840.00 |
| D0602 |
|
72 |
72 |
$120.00 |
| D9993 |
|
315 |
315 |
$0.00 |