| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,406 |
1,000 |
$741K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,344 |
820 |
$303K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,109 |
1,113 |
$197K |
| D9222 |
|
1,109 |
1,109 |
$152K |
| D2929 |
|
744 |
236 |
$114K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
782 |
481 |
$67K |
| D2330 |
|
640 |
324 |
$66K |
| D0240 |
|
1,945 |
1,020 |
$37K |
| D0272 |
Bitewings - two radiographic images |
928 |
928 |
$18K |
| D2331 |
|
157 |
88 |
$17K |
| D1510 |
|
58 |
43 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
51 |
$10K |
| D1351 |
Sealant - per tooth |
292 |
108 |
$9K |