| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18,020 |
1,408 |
$1.40M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14,889 |
1,328 |
$822K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,860 |
778 |
$188K |
| D0140 |
Limited oral evaluation - problem focused |
3,084 |
1,834 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,887 |
1,343 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
745 |
170 |
$36K |
| D2140 |
|
1,052 |
135 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,156 |
1,382 |
$18K |
| D8670 |
Periodic orthodontic treatment visit |
79 |
63 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
89 |
28 |
$7K |
| D7510 |
|
170 |
83 |
$6K |
| D1351 |
Sealant - per tooth |
78 |
12 |
$1K |