| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,738 |
718 |
$319K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,149 |
2,082 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,810 |
707 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,185 |
688 |
$107K |
| D9310 |
|
2,192 |
2,020 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,073 |
1,616 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
838 |
271 |
$56K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
136 |
107 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,559 |
2,319 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
429 |
236 |
$26K |
| D2390 |
|
171 |
41 |
$15K |
| D1120 |
Prophylaxis - child |
397 |
333 |
$12K |
| D9222 |
|
12 |
12 |
$8K |
| D1999 |
|
822 |
687 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
400 |
334 |
$6K |
| D1351 |
Sealant - per tooth |
240 |
111 |
$6K |
| D0330 |
Panoramic radiographic image |
31 |
27 |
$920.00 |
| D0350 |
|
319 |
303 |
$21.60 |