| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,329 |
664 |
$287K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
983 |
321 |
$95K |
| D9310 |
|
1,897 |
1,869 |
$93K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
557 |
105 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
1,822 |
1,550 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
436 |
132 |
$25K |
| D2933 |
|
149 |
43 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
378 |
286 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,005 |
688 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
143 |
64 |
$9K |
| D1351 |
Sealant - per tooth |
176 |
55 |
$7K |
| D2390 |
|
57 |
14 |
$6K |