| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,062 |
2,825 |
$1.26M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,388 |
2,945 |
$715K |
| D9222 |
|
385 |
385 |
$616K |
| D1120 |
Prophylaxis - child |
9,699 |
9,599 |
$454K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,535 |
2,213 |
$405K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,953 |
1,512 |
$336K |
| D9248 |
|
1,257 |
1,230 |
$332K |
| D0120 |
Periodic oral evaluation - established patient |
10,771 |
10,641 |
$310K |
| D1206 |
Topical application of fluoride varnish |
11,668 |
11,522 |
$262K |
| D1351 |
Sealant - per tooth |
6,879 |
1,718 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,502 |
1,614 |
$240K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,538 |
3,436 |
$218K |
| D0272 |
Bitewings - two radiographic images |
6,689 |
6,587 |
$153K |
| D2934 |
|
492 |
166 |
$103K |
| D1110 |
Prophylaxis - adult |
1,793 |
1,775 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,526 |
2,510 |
$92K |
| D1510 |
|
539 |
417 |
$87K |
| D0240 |
|
2,553 |
1,875 |
$60K |
| D1330 |
|
6,885 |
6,808 |
$57K |
| D1310 |
|
5,683 |
5,615 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,089 |
2,051 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,259 |
1,029 |
$26K |
| D2330 |
|
332 |
198 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
202 |
157 |
$24K |
| D9920 |
|
130 |
126 |
$19K |
| D0603 |
|
1,609 |
1,603 |
$16K |
| D2332 |
|
147 |
102 |
$15K |
| D2331 |
|
141 |
100 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
131 |
$7K |
| D2920 |
|
112 |
98 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
96 |
$3K |
| D0602 |
|
130 |
130 |
$1K |
| D1999 |
|
66 |
65 |
$385.00 |
| D0270 |
|
37 |
37 |
$315.65 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
379 |
379 |
$0.00 |