| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,781 |
488 |
$193K |
| D9220 |
|
769 |
690 |
$114K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,118 |
429 |
$74K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
605 |
254 |
$60K |
| D9610 |
|
649 |
640 |
$52K |
| D9420 |
|
671 |
665 |
$47K |
| D2140 |
|
505 |
257 |
$27K |
| D2330 |
|
351 |
198 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
478 |
202 |
$26K |
| D9221 |
|
417 |
360 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
664 |
639 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
303 |
303 |
$14K |
| D1120 |
Prophylaxis - child |
379 |
374 |
$10K |
| D2160 |
|
105 |
68 |
$8K |
| D0272 |
Bitewings - two radiographic images |
632 |
628 |
$7K |
| D2332 |
|
70 |
41 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
232 |
232 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
398 |
381 |
$6K |
| D1510 |
|
31 |
27 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
100 |
100 |
$3K |
| D1351 |
Sealant - per tooth |
77 |
30 |
$2K |