| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15,419 |
4,925 |
$2.41M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
11,442 |
5,985 |
$2.37M |
| D7140 |
Extraction, erupted tooth or exposed root |
22,175 |
7,311 |
$1.42M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13,637 |
5,052 |
$976K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81,534 |
34,253 |
$725K |
| D9222 |
|
4,231 |
4,213 |
$663K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,261 |
2,962 |
$620K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,168 |
3,161 |
$575K |
| D9310 |
|
10,970 |
10,750 |
$499K |
| D0120 |
Periodic oral evaluation - established patient |
19,265 |
19,024 |
$409K |
| D1120 |
Prophylaxis - child |
22,593 |
22,205 |
$385K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,903 |
11,688 |
$348K |
| D1510 |
|
1,830 |
1,207 |
$330K |
| D9610 |
|
2,651 |
1,909 |
$329K |
| D9999 |
Unspecified adjunctive procedure, by report |
4,447 |
4,355 |
$319K |
| D1206 |
Topical application of fluoride varnish |
15,092 |
14,898 |
$294K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,159 |
8,266 |
$257K |
| D0220 |
Intraoral - periapical first radiographic image |
38,058 |
37,017 |
$223K |
| D2140 |
|
3,473 |
1,818 |
$215K |
| D1351 |
Sealant - per tooth |
10,174 |
3,561 |
$196K |
| D0272 |
Bitewings - two radiographic images |
17,798 |
17,498 |
$158K |
| D0330 |
Panoramic radiographic image |
10,273 |
10,129 |
$152K |
| D2160 |
|
1,723 |
1,107 |
$150K |
| D2330 |
|
1,873 |
1,076 |
$149K |
| D1310 |
|
19,825 |
19,369 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
6,911 |
6,773 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,537 |
5,249 |
$123K |
| D2331 |
|
1,588 |
1,021 |
$121K |
| D1110 |
Prophylaxis - adult |
3,819 |
3,782 |
$106K |
| D7230 |
|
504 |
272 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,645 |
11,407 |
$86K |
| D4341 |
|
3,817 |
1,734 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
2,515 |
2,398 |
$44K |
| D0603 |
|
12,859 |
12,551 |
$41K |
| D0274 |
Bitewings - four radiographic images |
8,197 |
8,097 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,660 |
1,408 |
$34K |
| D9220 |
|
147 |
145 |
$34K |
| D0350 |
|
4,896 |
2,896 |
$23K |
| D9221 |
|
182 |
144 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
118 |
114 |
$15K |
| D9430 |
|
2,477 |
2,389 |
$13K |
| D2931 |
|
107 |
82 |
$12K |
| D1999 |
|
646 |
637 |
$12K |
| D0601 |
|
6,959 |
6,855 |
$10K |
| D0999 |
Unspecified diagnostic procedure, by report |
225 |
225 |
$8K |
| D2332 |
|
52 |
27 |
$5K |
| D0602 |
|
4,470 |
4,372 |
$5K |
| D9993 |
|
22,067 |
21,598 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
26 |
18 |
$3K |
| D7220 |
|
19 |
13 |
$3K |
| D2940 |
|
45 |
25 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
118 |
115 |
$1K |
| D0270 |
|
2,509 |
2,432 |
$737.00 |
| D3120 |
|
38 |
23 |
$728.80 |
| D9986 |
|
1,915 |
1,888 |
$0.00 |
| D9987 |
|
516 |
512 |
$0.00 |
| D2950 |
|
166 |
152 |
$0.00 |
| D1320 |
|
520 |
520 |
$0.00 |
| D1330 |
|
499 |
490 |
$0.00 |
| D7250 |
|
22 |
13 |
$0.00 |