| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,519 |
1,187 |
$1.01M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,195 |
1,224 |
$611K |
| D3240 |
|
1,848 |
656 |
$181K |
| D9222 |
|
1,207 |
1,205 |
$135K |
| D3230 |
|
973 |
339 |
$94K |
| D9610 |
|
2,013 |
1,218 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,339 |
425 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,076 |
1,056 |
$69K |
| D2330 |
|
276 |
140 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
130 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
315 |
168 |
$17K |
| D0350 |
|
1,296 |
478 |
$13K |
| D1510 |
|
51 |
34 |
$10K |
| D0272 |
Bitewings - two radiographic images |
699 |
688 |
$8K |
| D1351 |
Sealant - per tooth |
184 |
71 |
$7K |
| D0240 |
|
704 |
416 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,017 |
528 |
$7K |
| D0270 |
|
15 |
12 |
$60.00 |