| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,083 |
1,487 |
$881K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,812 |
658 |
$473K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,978 |
1,075 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,880 |
987 |
$205K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,973 |
2,566 |
$148K |
| D9222 |
|
682 |
654 |
$111K |
| D9310 |
|
2,147 |
2,140 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,757 |
1,573 |
$94K |
| D2332 |
|
636 |
376 |
$76K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
535 |
347 |
$54K |
| D1351 |
Sealant - per tooth |
1,225 |
561 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,277 |
2,246 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,293 |
2,204 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
412 |
284 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
602 |
$29K |
| D1120 |
Prophylaxis - child |
389 |
384 |
$20K |
| D2330 |
|
148 |
90 |
$13K |
| D1206 |
Topical application of fluoride varnish |
384 |
379 |
$11K |
| D0350 |
|
1,170 |
594 |
$10K |
| D1510 |
|
16 |
12 |
$4K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$2K |