| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,143 |
2,079 |
$994K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,666 |
1,182 |
$941K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,932 |
1,949 |
$428K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,358 |
1,742 |
$426K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,139 |
1,362 |
$241K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,505 |
4,071 |
$226K |
| D9310 |
|
4,038 |
3,943 |
$195K |
| D9222 |
|
1,160 |
1,136 |
$184K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,099 |
749 |
$152K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,280 |
1,927 |
$126K |
| D1510 |
|
649 |
481 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
4,901 |
4,696 |
$74K |
| D1351 |
Sealant - per tooth |
1,567 |
595 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
718 |
457 |
$59K |
| D0272 |
Bitewings - two radiographic images |
3,455 |
3,357 |
$50K |
| D0330 |
Panoramic radiographic image |
293 |
289 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
292 |
291 |
$10K |
| D1120 |
Prophylaxis - child |
154 |
153 |
$9K |
| D9221 |
|
33 |
14 |
$9K |
| D2332 |
|
67 |
41 |
$8K |
| D2933 |
|
29 |
12 |
$5K |
| D9220 |
|
19 |
14 |
$4K |
| D9610 |
|
190 |
114 |
$2K |
| D1999 |
|
133 |
126 |
$710.00 |
| D0350 |
|
33 |
29 |
$82.80 |