| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26,385 |
7,810 |
$2.95M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15,269 |
5,991 |
$1.40M |
| D0120 |
Periodic oral evaluation - established patient |
24,154 |
24,004 |
$1.37M |
| D1120 |
Prophylaxis - child |
34,292 |
33,995 |
$1.31M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,827 |
2,583 |
$1.13M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,455 |
8,389 |
$932K |
| D0350 |
|
105,613 |
34,518 |
$830K |
| D1351 |
Sealant - per tooth |
22,800 |
7,011 |
$643K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,612 |
9,591 |
$621K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,053 |
5,533 |
$602K |
| D1310 |
|
13,715 |
13,497 |
$563K |
| D0230 |
Intraoral - periapical each additional radiographic image |
116,901 |
34,649 |
$515K |
| D9993 |
|
8,795 |
8,618 |
$488K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,780 |
33,483 |
$483K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,914 |
10,478 |
$460K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,252 |
5,703 |
$434K |
| D0274 |
Bitewings - four radiographic images |
13,212 |
13,073 |
$263K |
| D9222 |
|
2,054 |
2,042 |
$242K |
| D3230 |
|
1,860 |
683 |
$174K |
| D0272 |
Bitewings - two radiographic images |
14,111 |
14,012 |
$160K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,580 |
2,573 |
$157K |
| D0603 |
|
10,065 |
9,891 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
9,270 |
8,955 |
$107K |
| D2330 |
|
1,347 |
903 |
$98K |
| D0330 |
Panoramic radiographic image |
3,201 |
3,156 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,112 |
635 |
$88K |
| D9310 |
|
2,180 |
2,078 |
$81K |
| D1510 |
|
420 |
285 |
$55K |
| D9430 |
|
1,750 |
1,712 |
$55K |
| D2934 |
|
447 |
75 |
$35K |
| D0602 |
|
1,494 |
1,484 |
$22K |
| D0601 |
|
982 |
970 |
$14K |
| D9220 |
|
160 |
146 |
$14K |
| D9221 |
|
686 |
134 |
$10K |
| D2940 |
|
1,278 |
407 |
$7K |
| D0270 |
|
1,527 |
1,431 |
$7K |
| D2332 |
|
21 |
13 |
$455.00 |
| D9920 |
|
30 |
28 |
$140.00 |