| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
286 |
69 |
$57K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
366 |
71 |
$38K |
| D9222 |
|
71 |
71 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
13 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$233.63 |