| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,745 |
6,714 |
$444K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,928 |
711 |
$347K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,225 |
712 |
$318K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,947 |
2,208 |
$260K |
| D1120 |
Prophylaxis - child |
5,570 |
5,485 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
3,405 |
3,381 |
$242K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,020 |
1,047 |
$238K |
| D9430 |
|
7,548 |
6,124 |
$236K |
| D7240 |
Removal of impacted tooth - completely bony |
1,009 |
388 |
$230K |
| D0210 |
Intraoral - complete series of radiographic images |
4,819 |
4,810 |
$228K |
| D2335 |
|
1,811 |
724 |
$213K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,479 |
1,671 |
$193K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
623 |
445 |
$187K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,682 |
7,828 |
$149K |
| D1310 |
|
3,160 |
3,116 |
$140K |
| D1206 |
Topical application of fluoride varnish |
6,084 |
5,998 |
$117K |
| D0350 |
|
10,748 |
4,572 |
$114K |
| D2740 |
Crown - porcelain/ceramic |
212 |
184 |
$99K |
| D0330 |
Panoramic radiographic image |
3,147 |
3,103 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
7,945 |
7,004 |
$93K |
| D1351 |
Sealant - per tooth |
2,656 |
855 |
$91K |
| D2330 |
|
1,005 |
387 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,307 |
646 |
$74K |
| D1320 |
|
5,072 |
5,065 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,742 |
1,599 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
783 |
769 |
$54K |
| D9222 |
|
446 |
445 |
$54K |
| D7230 |
|
252 |
161 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
838 |
495 |
$44K |
| D9610 |
|
619 |
444 |
$37K |
| D0603 |
|
2,458 |
2,421 |
$36K |
| D0272 |
Bitewings - two radiographic images |
3,325 |
3,267 |
$32K |
| D1354 |
|
2,670 |
468 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,420 |
1,411 |
$29K |
| D1110 |
Prophylaxis - adult |
304 |
304 |
$26K |
| D4910 |
|
338 |
334 |
$25K |
| D9993 |
|
406 |
406 |
$20K |
| D2394 |
|
196 |
170 |
$16K |
| D0602 |
|
572 |
566 |
$8K |
| D9920 |
|
58 |
55 |
$8K |
| D2940 |
|
89 |
85 |
$5K |
| D4341 |
|
68 |
18 |
$5K |
| D7220 |
|
18 |
12 |
$3K |