| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,459 |
2,005 |
$1.29M |
| D7140 |
Extraction, erupted tooth or exposed root |
2,015 |
1,286 |
$540K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
247 |
205 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
135 |
$46K |
| D2934 |
|
61 |
47 |
$26K |
| D1351 |
Sealant - per tooth |
111 |
56 |
$26K |
| D2330 |
|
128 |
102 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
51 |
$15K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
73 |
69 |
$9K |
| D2390 |
|
43 |
26 |
$8K |
| D2932 |
|
20 |
12 |
$6K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
12 |
12 |
$2K |
| D2331 |
|
12 |
12 |
$2K |