| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,389 |
298 |
$155K |
| D9310 |
|
1,107 |
1,059 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,624 |
934 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
740 |
583 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
501 |
179 |
$30K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
62 |
51 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,149 |
1,024 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
134 |
74 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
122 |
50 |
$9K |
| D0272 |
Bitewings - two radiographic images |
479 |
448 |
$4K |
| D1999 |
|
402 |
345 |
$3K |
| D1120 |
Prophylaxis - child |
15 |
14 |
$315.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$126.00 |