| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,030 |
1,480 |
$573K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,879 |
1,596 |
$306K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,559 |
3,416 |
$203K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,626 |
3,183 |
$200K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,522 |
1,297 |
$192K |
| D9310 |
|
3,696 |
3,603 |
$181K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,700 |
1,044 |
$162K |
| D0220 |
Intraoral - periapical first radiographic image |
3,589 |
3,464 |
$54K |
| D1351 |
Sealant - per tooth |
646 |
248 |
$27K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
169 |
26 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
129 |
$16K |
| D1510 |
|
66 |
49 |
$12K |
| D1999 |
|
1,155 |
1,012 |
$10K |
| D0272 |
Bitewings - two radiographic images |
621 |
582 |
$8K |
| D9222 |
|
26 |
26 |
$4K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$742.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$570.00 |