| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,289 |
2,224 |
$1.14M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,053 |
2,136 |
$193K |
| D9420 |
|
2,680 |
2,635 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
2,674 |
2,629 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,282 |
634 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
3,290 |
3,245 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
710 |
433 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,384 |
727 |
$29K |
| D2330 |
|
1,203 |
643 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,682 |
2,636 |
$27K |
| D1351 |
Sealant - per tooth |
4,506 |
1,340 |
$19K |
| D2335 |
|
300 |
129 |
$17K |
| D3120 |
|
1,090 |
475 |
$9K |
| D2934 |
|
183 |
73 |
$7K |
| D0350 |
|
1,139 |
1,098 |
$5K |
| D0603 |
|
5,079 |
4,778 |
$5K |
| D2332 |
|
89 |
54 |
$4K |
| D1330 |
|
2,676 |
2,630 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
20 |
15 |
$2K |
| D9222 |
|
20 |
15 |
$610.00 |
| D9612 |
|
20 |
15 |
$0.00 |