| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,270 |
762 |
$433K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,320 |
801 |
$240K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,852 |
631 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,101 |
2,039 |
$127K |
| D9420 |
|
1,106 |
1,095 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
667 |
665 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
224 |
129 |
$30K |
| D2335 |
|
87 |
36 |
$16K |
| D7962 |
|
52 |
49 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
93 |
60 |
$11K |
| D7961 |
|
43 |
40 |
$10K |
| D1510 |
|
42 |
26 |
$9K |
| D1351 |
Sealant - per tooth |
213 |
80 |
$7K |
| D7960 |
|
12 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$407.68 |