| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,301 |
2,714 |
$1.56M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,870 |
1,747 |
$878K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
3,402 |
1,811 |
$766K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,280 |
1,109 |
$363K |
| D1120 |
Prophylaxis - child |
1,999 |
1,858 |
$199K |
| D2934 |
|
431 |
349 |
$163K |
| 42830 |
|
327 |
317 |
$127K |
| D2330 |
|
456 |
407 |
$120K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
271 |
264 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
356 |
308 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
291 |
$78K |
| D2932 |
|
126 |
101 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
335 |
321 |
$35K |
| 31622 |
|
290 |
281 |
$28K |
| 66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis |
235 |
177 |
$10K |
| D2929 |
|
26 |
24 |
$9K |
| D2332 |
|
33 |
26 |
$7K |
| D1351 |
Sealant - per tooth |
13 |
13 |
$4K |
| D1510 |
|
13 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$1K |