| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,476 |
602 |
$262K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
350 |
311 |
$159K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,135 |
1,660 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,446 |
510 |
$86K |
| D9310 |
|
1,667 |
1,632 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
967 |
492 |
$77K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,043 |
372 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,143 |
909 |
$44K |
| D2390 |
|
386 |
123 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
484 |
245 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,108 |
1,944 |
$28K |
| D1120 |
Prophylaxis - child |
417 |
378 |
$11K |
| D2330 |
|
145 |
57 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
356 |
324 |
$4K |
| D1351 |
Sealant - per tooth |
111 |
68 |
$2K |
| D0330 |
Panoramic radiographic image |
67 |
63 |
$2K |
| D1999 |
|
152 |
133 |
$1K |