| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,353 |
1,921 |
$1.58M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
6,567 |
1,734 |
$527K |
| D9420 |
|
2,224 |
2,202 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,364 |
684 |
$158K |
| D2335 |
|
550 |
212 |
$70K |
| D2330 |
|
977 |
328 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,149 |
319 |
$63K |
| D2934 |
|
395 |
130 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,145 |
2,138 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
819 |
817 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,137 |
2,129 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,019 |
1,016 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,146 |
2,127 |
$19K |
| D1120 |
Prophylaxis - child |
1,004 |
998 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
942 |
937 |
$9K |
| D1510 |
|
19 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
73 |
28 |
$2K |
| D1206 |
Topical application of fluoride varnish |
94 |
93 |
$2K |