| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,209 |
1,423 |
$975K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,255 |
1,981 |
$904K |
| D9222 |
|
1,976 |
1,976 |
$238K |
| D9420 |
|
2,691 |
1,955 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,044 |
943 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,172 |
2,151 |
$139K |
| D9610 |
|
3,263 |
1,594 |
$87K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
768 |
352 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,405 |
2,043 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
656 |
282 |
$44K |
| D1120 |
Prophylaxis - child |
1,401 |
1,397 |
$42K |
| D1351 |
Sealant - per tooth |
1,060 |
333 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
454 |
197 |
$24K |
| D1310 |
|
986 |
984 |
$24K |
| D0350 |
|
1,976 |
1,088 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,727 |
1,707 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,194 |
1,190 |
$17K |
| D0603 |
|
997 |
995 |
$7K |
| D2330 |
|
61 |
33 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
200 |
200 |
$2K |
| D2332 |
|
15 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
52 |
$528.00 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$96.00 |