| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,534 |
1,510 |
$1.02M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,912 |
1,256 |
$478K |
| D1120 |
Prophylaxis - child |
7,155 |
7,128 |
$342K |
| D0120 |
Periodic oral evaluation - established patient |
4,304 |
4,288 |
$294K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,076 |
731 |
$291K |
| D3230 |
|
2,226 |
620 |
$217K |
| D1310 |
|
3,861 |
3,835 |
$166K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,015 |
6,989 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,514 |
7,182 |
$127K |
| D0350 |
|
16,388 |
5,418 |
$124K |
| D1351 |
Sealant - per tooth |
3,260 |
947 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,925 |
857 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,582 |
1,578 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,443 |
886 |
$102K |
| D9222 |
|
734 |
733 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,279 |
730 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,269 |
1,078 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
716 |
716 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,576 |
3,519 |
$43K |
| D0603 |
|
2,302 |
2,291 |
$32K |
| D1510 |
|
154 |
107 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,479 |
1,478 |
$31K |
| D9993 |
|
458 |
458 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,984 |
1,976 |
$22K |
| D9430 |
|
517 |
499 |
$17K |
| D0602 |
|
664 |
664 |
$9K |
| D9310 |
|
151 |
151 |
$8K |
| D2330 |
|
91 |
53 |
$7K |
| D0330 |
Panoramic radiographic image |
183 |
183 |
$5K |
| D0601 |
|
293 |
293 |
$4K |