| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21,510 |
2,977 |
$3.02M |
| D7140 |
Extraction, erupted tooth or exposed root |
3,910 |
1,457 |
$225K |
| D1351 |
Sealant - per tooth |
5,526 |
1,600 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,861 |
3,853 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,544 |
714 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,139 |
3,070 |
$99K |
| D9420 |
|
2,592 |
2,552 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,843 |
1,787 |
$86K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,035 |
476 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
4,343 |
4,201 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,965 |
1,929 |
$32K |
| D2934 |
|
86 |
18 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
403 |
393 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
37 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
13 |
$325.32 |
| D7111 |
|
42 |
12 |
$309.69 |
| D0603 |
|
3,572 |
3,477 |
$0.00 |