| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
7,123 |
3,330 |
$1.84M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,098 |
3,051 |
$1.56M |
| D9420 |
|
6,786 |
4,349 |
$544K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,395 |
1,656 |
$435K |
| D9221 |
|
1,934 |
1,020 |
$422K |
| D9222 |
|
3,331 |
3,327 |
$408K |
| D9610 |
|
6,160 |
4,352 |
$359K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,541 |
1,641 |
$303K |
| D9220 |
|
1,028 |
1,021 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,122 |
3,103 |
$193K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,113 |
1,037 |
$177K |
| D0350 |
|
11,371 |
3,107 |
$114K |
| D2330 |
|
1,356 |
588 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,213 |
3,941 |
$89K |
| D0272 |
Bitewings - two radiographic images |
3,846 |
3,835 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
298 |
158 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
399 |
180 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,965 |
1,953 |
$17K |
| D1120 |
Prophylaxis - child |
258 |
257 |
$3K |
| D2331 |
|
26 |
12 |
$2K |
| D9430 |
|
60 |
60 |
$2K |