| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,945 |
893 |
$460K |
| D9220 |
|
1,180 |
1,136 |
$241K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,619 |
453 |
$157K |
| D9610 |
|
1,871 |
1,749 |
$144K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
948 |
583 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,034 |
641 |
$115K |
| D9221 |
|
1,176 |
763 |
$108K |
| D9420 |
|
1,629 |
1,482 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,294 |
1,286 |
$79K |
| D9222 |
|
611 |
610 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
789 |
295 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,875 |
1,012 |
$39K |
| D1120 |
Prophylaxis - child |
1,578 |
1,568 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
382 |
382 |
$17K |
| D2140 |
|
306 |
149 |
$16K |
| D0272 |
Bitewings - two radiographic images |
937 |
934 |
$11K |
| D1206 |
Topical application of fluoride varnish |
1,504 |
1,494 |
$8K |
| D2932 |
|
40 |
12 |
$4K |
| D1351 |
Sealant - per tooth |
222 |
65 |
$4K |
| D0350 |
|
602 |
341 |
$2K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
28 |
27 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$1K |
| D9920 |
|
223 |
223 |
$1K |