| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,814 |
425 |
$102K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
873 |
302 |
$35K |
| D9420 |
|
491 |
488 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
511 |
196 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
504 |
191 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
624 |
619 |
$16K |
| D2934 |
|
223 |
73 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
579 |
574 |
$16K |
| D2330 |
|
475 |
178 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
250 |
109 |
$9K |
| D9310 |
|
502 |
499 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
290 |
289 |
$7K |
| D2332 |
|
72 |
38 |
$3K |
| D1351 |
Sealant - per tooth |
124 |
39 |
$1K |
| D1330 |
|
13 |
13 |
$0.00 |
| D0603 |
|
312 |
292 |
$0.00 |