| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,303 |
754 |
$294K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,686 |
370 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,728 |
815 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,386 |
2,053 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,430 |
571 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,073 |
1,678 |
$80K |
| D9310 |
|
1,526 |
1,485 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
620 |
309 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,073 |
2,907 |
$41K |
| D9221 |
|
87 |
18 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
152 |
94 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
45 |
$9K |
| D9222 |
|
45 |
44 |
$7K |
| D9220 |
|
19 |
18 |
$6K |
| D1510 |
|
38 |
24 |
$5K |
| D1120 |
Prophylaxis - child |
206 |
192 |
$5K |
| D2330 |
|
23 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
163 |
155 |
$1K |
| D1999 |
|
211 |
196 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
141 |
131 |
$1K |
| D1310 |
|
1,107 |
1,079 |
$0.00 |
| D0603 |
|
1,088 |
1,061 |
$0.00 |
| D9993 |
|
1,106 |
1,079 |
$0.00 |