| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,450 |
625 |
$390K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
478 |
305 |
$329K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,875 |
853 |
$201K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,547 |
456 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,287 |
2,128 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,326 |
506 |
$100K |
| D9310 |
|
1,721 |
1,696 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,228 |
1,156 |
$69K |
| D9222 |
|
291 |
291 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,672 |
2,546 |
$41K |
| D9610 |
|
742 |
273 |
$37K |
| D1120 |
Prophylaxis - child |
285 |
264 |
$16K |
| D1351 |
Sealant - per tooth |
283 |
138 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
85 |
$12K |
| D2332 |
|
82 |
41 |
$10K |
| D1206 |
Topical application of fluoride varnish |
265 |
243 |
$9K |
| D1354 |
|
343 |
50 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
366 |
366 |
$5K |
| D0272 |
Bitewings - two radiographic images |
195 |
175 |
$2K |
| D0350 |
|
600 |
588 |
$752.40 |
| D1999 |
|
99 |
90 |
$440.00 |
| D0603 |
|
21 |
21 |
$0.00 |