| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28,813 |
4,838 |
$3.34M |
| 41899 |
Unlisted procedure, dentoalveolar structures |
1,955 |
1,944 |
$2.08M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15,969 |
3,961 |
$1.57M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,477 |
4,725 |
$817K |
| D0120 |
Periodic oral evaluation - established patient |
11,287 |
11,253 |
$611K |
| D1510 |
|
3,357 |
2,103 |
$539K |
| D1120 |
Prophylaxis - child |
15,272 |
15,232 |
$525K |
| D9420 |
|
6,065 |
5,217 |
$445K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,712 |
2,708 |
$439K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,279 |
5,264 |
$331K |
| D0230 |
Intraoral - periapical each additional radiographic image |
64,030 |
16,330 |
$300K |
| D2140 |
|
4,789 |
2,328 |
$256K |
| D2330 |
|
3,075 |
1,769 |
$230K |
| D1351 |
Sealant - per tooth |
7,453 |
2,267 |
$212K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
1,814 |
1,810 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,268 |
15,228 |
$150K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
1,142 |
946 |
$147K |
| D0350 |
|
8,101 |
4,787 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
8,198 |
8,110 |
$94K |
| D0272 |
Bitewings - two radiographic images |
6,673 |
6,655 |
$78K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
920 |
916 |
$75K |
| D0274 |
Bitewings - four radiographic images |
3,348 |
3,333 |
$71K |
| D0145 |
Oral evaluation for a patient under three years of age |
970 |
965 |
$55K |
| D1310 |
|
989 |
989 |
$44K |
| 99218 |
|
1,292 |
642 |
$39K |
| 99199 |
Unlisted special service, procedure or report |
471 |
115 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
331 |
331 |
$14K |
| 0360 |
|
152 |
122 |
$14K |
| D0603 |
|
623 |
623 |
$9K |
| 99070 |
|
932 |
932 |
$8K |
| J3490 |
Unclassified drugs |
230 |
229 |
$6K |
| D9430 |
|
174 |
172 |
$5K |
| 0490 |
|
111 |
109 |
$5K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
134 |
134 |
$3K |
| 0760 |
|
124 |
122 |
$3K |
| D0601 |
|
187 |
187 |
$3K |
| 0710 |
|
124 |
122 |
$2K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
319 |
297 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
179 |
178 |
$2K |
| D2160 |
|
17 |
12 |
$1K |
| 99221 |
|
608 |
304 |
$0.00 |